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3. 
   City of North Miami
   Quasi-Judicial Speaker Form
5. Submit this form to the City Clerk prior to the comment period for the subject item or tab. The following guidelines govern the public forum:
   1. Speakers will speak in the order called by the Mayor.
   2. When a speaker’s name is called, they should approach the podium and state their name and address for the record.
   3. Comments should be kept to no more than 2 minutes in length.
   4. Speakers will address their comments to the City Council as a whole.
   5. There will be no questions asked of individual council members.
   6. Individual council members who wish to ask a question of a speaker may request recognition from the Mayor.
7. Choose One:

   1. In Favor Of

   1. Against

   1. Speak on the Item
9. Registered lobbyist with North Miami?

   1. Yes

   1. No
11. Agenda Item/Tab:
12. Date:
    Date:
14. Full Name
15. Email Address
17. Address
19. City
20. State
21. Zip Code
23. Phone Number

25. “I solemnly swear or affirm to tell the truth, the whole truth, and nothing but the truth”.
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature
31. This document is a public record pursuant to Article I, Section 24 of the Florida Constitution.
Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field