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2. Form must be submitted by 5pm the day of the meeting in order to be put on the agenda.
4. First Name*
5. Last Name*
7. Business/Residential Street Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Email Address
16. Date of meeting applicant requests to speak:*
    Date of meeting applicant requests to speak:
18. Subject to be addressed by the applicant:
20. Has the Applicant previously discussed this subject with City Officials or Employees or other City Committees?

    1. Yes
    2. No
22. If yes, please state name and approximate date.
24. Public Participation Rules
    The City Council has adopted the following procedures with respect to citizens addressing its meetings:
26. 1. Speaker shall be limited to 3 minutes to address the Council. The City Clerk shall keep time for all speakers. The Clerk shall provide all speakers with a 30-second warning and shall notify all speakers of the conclusion of their allotted time.
28. 2. Speaker shall act and speak with decorum and conform to conventional social manner in speech, writing, dress, and behavior.
30. 3. Speaker must be concise and not repetitive of himself/herself or other speakers.
32. I have read and agree to follow the public participation rules when speaking before the council.*

    1. I agree
34. Electronic Signature*
36. Statement Regarding Our Compliance with the Americans with Disabilities Act (ADA)
    The City of Litchfield wishes to ensure that its programs, services, and activities are accessible to individuals with disabilities. All public meetings are wheelchair accessible.
38. Persons requiring an auxiliary aid or service for effective communications, or a modification of policies or procedures to participate in a program, service, or activity of the City of Litchfield should contact Lisa Montgomery as soon as possible in advance of the event.
40. We would appreciate advance notice of at least 48 hours for any requests to receive a meeting agenda in an alternate format or for other types of auxiliary aids or services that might be necessary for an individual to pull participate in our meetings. Please call Lisa Montgomery at 217-324-8151.
42. I have read the ADA Statement and agree to its requests.*

    1. I agree
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field