2. Last Name:*
3. First Name:*
5. Group Name:
7. Address:*
9. Email Address:*
11. Phone Number:*
13. Subject of Presentation:*
15. Please indicate if your presentation includes an audio/visual component: *

    1. Yes
    2. No
17. Meeting date(s) requested first choice:*
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19. Meeting date(s) requested second choice:*
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21. Purpose of Presentation: *
    -- Select One --Information OnlyRequesting Action by Council Requesting a letter of supportOther (Explain)
23. If other, please explain
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25. 1. Receive an email copy of this form.
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