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City of Cocoa Beach Speaker Card and Affidavit

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First Name
Last Name
Address1
Address2
City
State
Zip
PHONE NUMBER
E-MAIL ADDRESS
ORGANIZATION YOU ARE REPRESENTING, IF OTHER THAN SELF:
AGENDA ITEM NO.:
SUBJECT:
AFFIDAVIT
I swear or affirm, under penalty of perjury, that the factual representation, which I am about to give or present at the public hearing is truthful.
Signature
Please sign form and affidavit.
DATE
DATE
Speaking Rules
- Complete card prior to introduction of item
- Hand the completed card to City Clerk/Secretary
- Speaker will have 3 Minutes to Address the Subject
- Additional time may be extended if speaking for an organization
- Speaker will be called upon by the Mayor/Chair

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