Form Center

2. To request a speaker for your upcoming meeting or special event, please complete the form below. Once submitted, this form will act as an aid for City staff to schedule your request. This form does not serve as confirmation of the availability of your desired speaker/event.
4. CONTACT INFORMATION
6. First Name*
7. Last Name*
9. Email Address*
11. Title
13. Organization
15. Address
17. City
18. State
19. Zip Code
21. Telephone Number*
23. Fax Number
27. EVENT INFORMATION
29. Requested Date and Time
    Requested Date and Time

    Requested Date and Time
30. Name of Event
32. Event Address
34. Event City
35. Event State
36. Event Zip
38. Who will be in the Audience?
40. Size of Audience
41. Area of Interest/Specific Topic
45. SPEAKER INFORMATION
47. Due to the requirements of Florida’s Government in the Sunshine Law, Sec. 286.011, F.S., only one Councilmember may participate as a speaker at any one meeting/event.
49. Do you have a specific Councilmember you would like to request?*
    -- Select One --No PreferenceMayor Chelsea ReedVice Mayor Rachelle LittCouncilmember Carl WoodsCouncilmember Mark MarcianoCouncilmember Marcie Tinsley
51. Additional Comments / Questions
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field