City of Temple Terrace Customer Service

REQUEST TO ADDRESS

2. 
3. Instructions
   If you wish to address items on the agenda at an upcoming meeting, complete this form, choose a method by which your comments will be delivered and submit. The length of each public comment is limited to what can be delivered via spoken word in three-minute. Special interest groups are encouraged to select a representative to speak for the group to conserve time and avoid repetition. Personal attacks, impertinent or slanderous remarks are not permitted. Any person making such remarks will be barred from making further comments.
5. First Name*
6. Last Name*
8. Address1
10. Address2
12. City*
13. State
14. Zip
16. Phone Number
17. Email Address
19. Title of agenda item*
    Please give title of the item on the agenda on which you wish to address
21. By which method would you like your comments to be delivered?*
    -- Select One --I would like my comments read into the record by City staff I will participate by telephone

    • Read into the record by City staff: Enter your statement in the field below to be read into the record during public comment. • Telephone: Dial the phone number and enter the access code on the agenda for the meeting. • Remote Public Participation at City Hall: A remote viewing station and public comment podium will be set up in the City Hall parking lot for citizens who wish to participate in this manner.
23. Statement
    Please provide your written statement, if available. (If you have chosen to have your comments read into the record by City staff, they must be included above.)
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

* indicates a required field