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2. Today’s Date
   Today’s Date
4. Date of Meeting to Attend
   Date of Meeting to Attend
6. Name*
8. Name of Organization
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone*
17. Email Address*
19. Brief description of topic to be discussed*
21. Documents

    Please attach any documents that you wish to be considered. Providing factual and background information will be helpful in reviewing your agenda request and will better prepare the Health and Human Relations Commission at the meeting. 

23. Please note: Please limit your time to 10 minutes when presenting to the Commission. Submission of this form does not ensure that you will be added to the meeting agenda. Someone will contact you to confirm your request.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field