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EVERETT CITY COUNCIL <br /> SPEAKERS REQUEST SHEET <br /> NOTE: PLEASE STALE YOUR NAME AND ADDRESS BEFORE YOU BEGIN <br /> PLEASE PRINT: <br /> • <br /> DATE: / I ' <br /> • <br /> • <br /> �1M4 n <br /> - NAME: /nI \D- res <br /> ADDRESS: 4 6a5- <br /> 61)./a6 <br /> CITY/STATE: f.VL U) P <br /> I wish to speak to the Everett City Council under "Citizens. Comments" or - <br /> "Audience Comments" regarding a topic that is not on the agenda. Briefly describe <br /> your t�o_ 'ic-below: <br /> • <br /> • <br /> • <br /> • <br /> I would like to comment on Agenda item # 7 on today's agenda. You will be <br /> given an opportunity to speak when that item is called. <br /> Each citizen is asked to limit comments to 3 minutes. The purpose of this practice is to allow all <br /> citizens a fair opportunity•to speak. If you wish to give a longer presentation, please contact the <br /> Council Office at (425) 257-8703, before you speak, either•in writing, or by phone, so that other <br /> arrangements may be made to allow you the time you may need. Please return this form office - <br /> completed to the Council Administrator before the meeting begins. - <br /> • <br /> • <br /> Project of Activity Title: Date: -. <br /> Meeting/Activity Location: • <br /> Everett City Council meeting 3002 Wetmore Avenue, Everett,Washington,98201 <br /> • <br /> Name(P lease Print): Gender: <br /> DMale DFemale <br /> General Ethnic Identification Category (please check one) <br /> • <br /> ❑Caucasian DHispanic American ❑American Indian/Alaskan Native <br /> DAfrican American ❑Asian/Pacific Island El Other <br /> • <br /> Color: : National Origin: <br /> "CIVIL RIGHTS ACT OF 1964,TITLE VI STATEMENT TO THE PUBLIC: The City of Everett hereby gives public notice that it is policy of - <br /> the City to assure full compliance with Title VI of the Civil Rights Act of 1964,the Civil Rights Restoration Act of 1987, and related statutes <br /> and regulations in all its programs and activities. Persons wishing information regarding the City's Title VI compliance may call 425-257- <br /> 8703, Title VI Specialist for the City Council." <br />