Request to Speak Card

The personal data collected on this form, is classified as a public record and may be made available to the public as provided by Utah Code § 63G.2.201.

******************************************************************

To proceed with completing the Duchesne County Volunteer Application Form, please select the ‘Next’ button to continue

Request To Speak Card

Duchesne County Commission
Contact Information
Name of Speaker*

First NameLast Name
Contact Person Email*
example@example.com
Contact Person Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Residence/Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Request Information
Commission Meeting Date*

MonthDayYear
Date
Agenda Item*
Please indicate your stance on the topic by selecting one option below:*

ProponentOpponentNeutral
Do you represent an Organization?*

YesNo
What Organization do you Represent?
Please give a brief overview of what you wish to discuss

0/200

Meeting Rules and Agreement

NOTICE: The following Meeting Rules of Order and Procedure established by the Board of Duchesne County Commissioners have been made available on the official Duchesne County website. To access the complete rules, please click [Here].

By providing my name and signature below, I acknowledge that I have thoroughly reviewed and understood the Meeting Rules of Order and Procedure. I hereby agree to comply with these rules in their entirety during the meeting.
Signature
Date

MonthDayYear
Date
IMPORTANT: Please be advised that your request to speak is subject to the review and discretion of the Commission. The contact person identified in this form will receive an official email notification confirming whether the request has been granted or denied.
Should be Empty:

Request To Speak Card