Agenda Request Form – FILL

Town of Mukwonago W320 S8315 Beulah Road Mukwonago, WI 53149 www.TownOfMukwonago.wi.gov Phone (262)363-4555 Fax (262)363-8377 AGENDA ITEM REQUEST FORM Due no later than 10 days prior to meeting date REQUESTED MEETING DATE: REQUESTER INFORMATION Name Address Telephone/Cell E-mail NATURE OF BUSINESS TO BE DISCUSSED (please provide complete details) Attach additional sheets and supporting information as necessary. To appear as a specific item of business on the Town of Mukwonago’s agenda, a complete and documented request must be received at the Town Clerk’s office no later than ten days prior to the meeting scheduled or requested. Business items on the agenda will be placed on a first come first serve basis. In the event of a full agenda, you will be placed on the next available agenda. Board meetings are held on the 3rd Wednesday of every month. Meetings begin at 6:30pm and are held in the Town Hall Meeting Room. SIGNATURE DATE OF REQUEST FOR OFFICE USE ONLY Date Received Received by