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2. Instructions

   Please complete and submit this form or email form (PDF) to board@cochise.az.gov prior to the start of the meeting. Complete a separate form for each item you wish to speak on.

4. Meeting Date
6. Please select ONE of the options below and complete.
8. Options*

   1. Public Hearing Agenda Item - I wish to speak on the item listed below
   2. Public Hearing Agenda Item - I do not wish to speak, but want my name and position read into the record
   3. Action Agenda Item - I wish to speak on the item listed below
   4. Action Agenda Item - I do not wish to speak, but want to be on the record. I understand that my name will not be read into the record.
   5. Call to the Public - I wish to address an issue on matters related to County Government but not on today's agenda
10. Call to the Public

    Concerning

12. Agenda Item Number
13. Agenda Item

    1. I support

    1. I am opposed
15. Full Name*
16. Phone*
18. Physical Address*
20. Mailing Address*

    Type "same as above" if same as physical address

22. Email
24. Organization/Group
25. How many people are you representing?
27. Please select *

    1. I plan to join via Microsoft Teams computer or mobile app, or via phone
    2. I plan to attend in-person
29. * indicates required field
33. Notes:
    • The agenda is broken into sections - Call to the Public, Public Hearings, etc. Select the category of the item you speak to speak on.
    • If you select – Public Hearing Agenda Item – I do not wish to speak, but want to be on record, the Chairman may announce your name and your position (in favor or opposed) on the agenda item.
    • During Call to the Public members of the Board may not discuss items that are not specifically identified on the agenda.
    • If several residents wish to address the Board on the same issue, it is recommended that a spokesperson be selected to present joint concerns to the Board.
    • If joining via Microsoft Teams computer or mobile app or via phone, please make sure the name/ organization/ phone number on this form matches the name/phone number in Teams.
    • The Chairman will call your name when it is your turn to speak.
    • The time allocated to each speaker to address the Board will be THREE MINUTES unless otherwise announced by the Chairman. An audible timer will be used. The Chairman of the Board reserves the right to extend speaker’s time.
    • If you have written comments for the Board you may also email them to board@cochise.az.gov.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field