Suffolk County Legislature Form Center

GENERAL MEETING SPEAKER CARD - PUBLIC PORTION

2. Date:*
   Date:

4. REQUEST TO ADDRESS THE SUFFOLK COUNTY LEGISLATURE
   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.

6. First Name:*

7. Last Name:*

9. E-Mail:*

11. Address:*

13. City:*

14. State:*

15. Zip Code:*

17. Phone Number:*

19. Representing:*

21. Topic:*

23. Device being used to speak: *

    1. Computer or Tablet

    1. Telephone
25. If using a computer or tablet, what is your device name:

27. If using a phone, what is your phone number:

29. If you require an interpreter, please specify the language below:

31. SPECIAL ACCOMODATION REQUESTS SHOULD BE DIRECTED TO THE CLERK OF THE LEGISLATURE AT (631) 853-4074.

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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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