Speaker Card
Board of Neighborhood Commissioners
Today's Date
-
Month
-
Day
Year
Date
Agenda Item Number
*
I wish to speak:
FOR this agenda item
AGAINST this agenda item
GENERAL COMMENTS regarding this agenda item
I do NOT wish to speak, but want to be recorded as:
FOR this item
AGAINST this item
Name
*
First Name
Last Name
Business or Organization Affiliation:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ARE YOU A PAID SPEAKER? IF YES, PLEASE PROVIDE CLIENT INFORMATION BELOW?
YES
NO
Client Name
Client Phone Number
-
Area Code
Phone Number
Client Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: