Public Meeting Participation Registration Card

CITY OF BERLIN Public Meeting Participation Registration Card Meeting Date: _________________________________________________________________ Governmental Body: ____________________________________________________________ Person Wishing to Speak: ________________________________________________________ Speaker Address (Must be completed to speak): ______________________________________ Is Speaker a resident of Berlin? Yes No Is Speaker: Individual or Group Representative Group Name: ______________________________________ Agenda Item to Speak to: _________________________________________________________ OR Issue to Speak To: _________________________________________________________________ CITY OF BERLIN Public Meeting Participation Registration Card Meeting Date: _________________________________________________________________ Governmental Body: ____________________________________________________________ Person Wishing to Speak: ________________________________________________________ Speaker Address (Must be completed to speak): ______________________________________ Is Speaker a resident of Berlin? Yes No Is Speaker: Individual or Group Representative Group Name: ______________________________________ Agenda Item to Speak to: _________________________________________________________ OR Issue to Speak To: _________________________________________________________________