Public Access Speaker Request Form

2. First Name

3. Last Name

5. Address

6. Postcode

8. Phone

9. Email

11. Representing (Self/Name of Organisation/Other Party)

13. Agenda Item

15. Please indicate if you are for or against the recommendation

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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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