CITY OF YUMA
City Council Meeting
Speaker Request Form
If you wish to address the City Council during the meeting, please complete the form below and submit it to the
City Clerk. Your name will be called when it is your turn to speak on the specific agenda item you marked
below.
Please print clearly to ensure that your name and address appear correctly in the official minutes of the meeting.
Name:__________________________________________ Phone # ___________________
(optional)
Address: ____________________________________________________ Zip: ___________
City Resident: Yes No
Please Check One Item:
Call to the Public: __________________________________________________________
Comments by speakers at Call to the Public should be related to City services, programs and/ or
activities.
If you have a concern regarding a specific City service, program or activity, please indicate if you
have been in contact with a City staff member? YES
NO
Agenda Item: _____________________________________________________________
Public Hearing Item: _______________________________________________________
Note to the Speaker –
The Yuma City Council values citizen comments and input. If you wish to speak to the City
Council please fill out the information on the reverse side of this card and turn it in to the City
Clerk.
Speaker request forms must be completed in advance of the meeting and can be submitted to the
City Clerk during normal office hours but no later than the start of the Council meeting. Please
complete one form for each item you want to address.
When the City Clerk calls your name, please approach the podium, state your name and
address for the record, and speak into the microphone so that City Council may hear your
comments.
If you intend to submit any written materials to the City Council, please also provide a copy to the
City Clerk.
Speakers wanting to comment on issues not listed on the agenda should be aware that the
Arizona Open Meeting Law permits City Council to discuss only those items listed on the agenda.
City Council may refer such items to the City Administrator.
Thank you for your participation in Yuma City government.
For Staff Use Only
Meeting Date _____________
Date/Time Rec’d:
