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2. Instructions
   Fill out the Opinion/Speaker Registration form below if you would like to submit a topic for the council agenda or register to speak with the Mayor and City Council. Form is due one week prior to the date of the Van City Council meeting.
   
   Welcome to the Van City Council meeting. Your presence and participation are appreciated. You may make your opinion known on an issue and/or register to speak to the Mayor and City Council.
   
   Please turn this form in at the staff table to forward it to the Mayor. Please step to the front as soon as the Mayor recognizes you and state your name and address before beginning your presentation. If you have written notes or other material you wish to present to the Mayor and council, please provide an extra copy for the official files.
4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Phone
17. Regarding Agenda Item Number
18. Council Meeting Date
20. Subject
21. Position

    1. For

    1. Against
23. Comments
25. Do you wish to address the Mayor and City Council?

    1. I wish to address the Mayor and City Council (Please limit address to 3 minutes).
    2. I do not wish to address the Mayor and City Council, but I do wish to register my opinion.
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field