Suffolk County Legislature Form Center

ADVISORY BODIES SPEAKER CARD - PUBLIC HEARING

2. Choose an Advisory Body*
   -- Select One --Fair Housing Task ForceFood Policy CouncilHeroin and Opiate Epidemic Advisory PanelLake Ronkonkoma Advisory BoardVanderbilt Museum

3. Public Hearing Date:*
   Public Hearing Date:

5. REQUEST TO ADDRESS THE ABOVE SELECTED ADVISORY BODY
   Speakers are limited to three (3) minutes. Longer statements may be submitted in writing to the Clerk for distribution and shall become part of the permanent record if desired.

   Speakers are limited to three (3) minutes. Longer statements may be submitted in writing to the Clerk for distribution and shall become part of the permanent record if desired.

7. First Name:*

8. Last Name:*

10. E-Mail:*

12. Address:*

14. City:*

15. State:*

16. Zip Code:*

18. Phone Number:*

20. Representing:

22. Topic:*

24. HANDICAPPED SERVICES AVAILABLE UPON REQUEST

Leave This Blank:


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

    This field is not part of the form submission.

28. Submit

* indicates a required field