Agenda Recognition Request Form

October 11th Fall Quarterly Meeting // Agenda Recognition Request Form

NOTE: This request must be submitted no later than 10 days prior to the scheduled meeting in which you would like to be recognized or speak at. Requests submitted after this deadline October 1st will not have the proper response time to be placed upon the agenda and will therefore be scheduled for the next consecutive meeting.
Are you currently an EMPOA member in good standing?*

YesNo
Please register at the official EMPOA Billing Portal to validate your account and ensure your membership dues are up to date prior to submitting this form.
Your registered EMPOA billing email*
example@example.com
Name*

First NameLast Name
Section & Lot Number
Phone Number*
Please enter a valid phone number.
Your Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Describe the issue you would like to discuss or be recognized for at the next scheduled meeting.*
Please attach any pertinent images or documents you may have pertaining to this request.

Optional
Cancelof
Please verify that you are human*
Should be Empty:

October 11th Fall Quarterly Meeting // Agenda Recognition Request Form