Appearance Request Form

Roanoke County Board of Supervisors
Request to Address the Board

PLEASE NOTE: All electronic submissions to speak at a Board meeting must be received by the Clerk's Office no later than 2:00 p.m. on the date of the meeting. Written requests may be submitted in person at the meeting following this time.

Meeting Date: Agenda Item No.

Public Hearing Ordinance Citizens Comments

SUBJECT:

I would like the Chairman of the Board of Supervisors to recognize me during the meeting on the above matter so that I may comment.

WHEN CALLED TO THE LECTERN, I WILL GIVE MY NAME AND ADDRESS FOR THE RECORD. I AGREE TO ABIDE BY THE GUIDELINES LISTED BELOW:

Each speaker will be given three (3) minutes to comment, whether speaking as an individual or representative. The Chairman will enforce the rule unless instructed by the majority of the Board to do otherwise. Individuals may not yield time to another speaker.
The speaker will be limited to a presentation of his/her point of view only. Questions of clarification may be entertained by the Chairman.
All comments must be directed to the Board. Debate between a recognized speaker and audience members is not allowed.
Both speakers and the audience will exercise courtesy at all times.
Speakers are requested to submit any written statements and/or comments to the Clerk to the Board.
It is at the discretion of the Chairman to allow an individual to speak on behalf of an organized group. Written authorization from the group allowing the individual to represent them shall be filed with the Clerk.

NAME:

Street Address:

City: State: Zip Code:

Email Address:

Area Code Phone Number:

Group/Organization:

Effective July 1, 2002, HB731 of the 2002 Virginia General Assembly updated the Virginia Freedom of Information Act. Email subscribers receiving information from a public body may, at their request, be exempt from having their email address given out should the email list be requested under the Freedom of Information Act (FOIA). If you would like to be exempted, please check yes below.

Exemption from Distribution:

	Yes - I want my email address to be excluded from any FOIA distributions.
	No - My email address may be included in any FOIA distributions.