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2. I request to speak during the public participation portion of the next City Council / Committee meeting in City Council Chambers. I will have the ability to address those present but understand that this will not be a question-and-answer format.

4. Meeting Date*
   Meeting Date
6. First Name*
7. Last Name*
9. Subject*
11. Speaker Interest

    1. Pro
    2. Con
13. Address*
15. Address Line 2
17. City*
18. State*
19. Zip Code*
21. Phone*

23. This completed Public Participation form must be received by the City of Rockford Legal Department no later than 3 pm on the day of the meeting in which you would like to participate. The Legal Department will call the above-listed phone number to confirm or if, for any reason, your request cannot be honored.

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

    This field is not part of the form submission.

27. Submit

* indicates a required field