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EVERETT CITY COUNCIL <br /> SPEAKERS REQUEST SHEET <br /> NOTE: PLEASE STATE YOUR NAME AND ADDRESS BEFORE YOU BEGIN <br /> PLEASE PRINT: <br /> kit q///,/ <br /> DATE: ©(— — ID Cti " <br /> NAME: ILL& <br /> ADDRESS: 1. <br /> CITY/STATE: V — A- <br /> I would like to comment on Agenda item # on today's agenda. You will be <br /> given an opportunity to speak when that item is called. <br /> I wish to speak to the Everett City Council under "Citizens Comments" regarding <br /> a topic that is not on the agenda. Brieflyji escribe our to ' ,below: <br /> = - - <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 once <br /> completed to the Council Administrator before the meeting begins. <br /> Project of Activity Title: Date: <br /> Meeting/Activity Location: <br /> Everett City.Council meeting 3002 Wetmore Avenue, Everett,Washington,98201 <br /> Name(Please Print): Gender: <br /> ❑Male ❑Female <br /> General Ethnic Identification Category (please check one) <br /> ❑Caucasian ❑Hispanic American ❑American Indian/Alaskan Native <br /> 0 African American 0 Asian/Pacific Island 0 Other <br /> Color: National Origin: <br /> "CIVIL RIGHTS ACT OF 1964, TITLE VI STATEMENT TO THE PUBLIC: The City of Everett hereby gives public notice <br /> that it is policy of the City to assure full compliance with Title VI of the Civil Rights Act of 1964, the Civil Rights <br /> Restoration Act of 1987, and related statutes and regulations in all its programs and activities. Persons wishing <br /> information regarding the City's Title VI compliance may call 425-257-8703, Title VI Specialist for the City Council." <br />