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<br /> <br />Eugene City Council <br /> <br />Request to Speak Form <br /> <br /> <br /> <br /> <br /> <br />Public ForumPublic Hearing <br />?? <br />(general comments at start of meeting) (refers to a specific topic on agenda) <br /> <br /> <br />Regarding <br /> <br /> <br />Regarding <br /> <br /> <br /> <br />Please complete this form before the agenda item is being discussed. Forms for the Public Forum must be submitted not <br />later than 15 minutes after the meeting has been called to order or before the end of the forum, whichever comes first. <br />Forms for any Public Hearing must be submitted by the time the hearing is called by the Mayor. Deliver this form to the <br />staff person at the information table at the north end of the Council Chamber. You will have three minutes to speak unless <br />informed otherwise. When your name is called, please step up to the podium and provide your name and address. Speak <br />directly into the microphone. Lights on the podium let you know when you have 15 seconds remaining (yellow light) and <br />when your time is up (red light). Forms will not be accepted after the deadline. Please refer to the reverse side for <br />additional information on the Public Forum and Public Hearing. <br /> <br />Please Print <br /> <br />Name <br />(Also spell your name as it sounds, if it is difficult to pronounce.) <br /> <br />Address Phone <br /> <br />City State Zip <br /> <br />Date <br /> <br /> <br /> <br /> <br />Would you like to be on our mailing list and receive notices of openings on various City of Eugene boards, <br />commissions or committees? If so, please complete the information below. <br /> <br />Please indicate (up to five) your area of interest(s). <br />?? <br /> Airport Land Use <br />?? <br /> Cultural Services Library <br /> <br />?? <br /> Downtown Eugene Neighborhood/Community Development <br /> <br />?? <br /> Economic Development Parks and Open Space <br />?? <br /> Environmental Recreation <br /> <br />?? <br />Financial Matters Public Safety <br />?? <br /> General Government Transportation <br />?? <br /> Housing Youth Issues <br />?? <br />Do you reside within the Eugene city limits? Yes No <br /> <br />Daytime Phone Evening Phone <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Fax E-Mail <br /> <br />?? <br />Are you currently a member of a City of Eugene advisory committee?Yes No <br />If yes, which one? <br /> <br />PLEASE SEE REVERSE FOR INFORMATION REGARDING THE PUBLIC FORUM AND PUBLIC HEARINGS <br /> L:\CMO\2006 Council Agendas\M060417\S060417A-attD.doc <br /> <br />