Public Comment Request Form Instant Impact Global Prep319 Highway 61 SouthNatchez, MS 39120info@instantimpactglobalprep.org Board Meeting Public Comment Request All interested persons may be provided an opportunity to present comments on any new business action agenda item. Any individual wishing to comment is required to register prior to the meeting. Comments must be related to a new business action agenda item and such person shall be required to identify the item to be addressed by the comment. Each person is allotted five (3) minutes, or an amount of time otherwise designated by the Chair, to provide comment to the Board. Full Name Organization Address Address Address Address City City State/Province State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone Email Date of Board Meeting New Business item to be addressed: Brief description of Public Comment Write your comment Signature of person making request Drop you signature here or click to upload Choose File Maximum upload size: 5MB Allowed file type: jpg, jpeg, jpe, png, gif Date If you are human, leave this field blank. Submit Δ
