1

Full Name

 *

Full Name

2

Contact's Telephone Number

 *

Contact's Telephone Numberext.

3

Contact's Email Address

 *

Contact's Email Address

4

Are you or any person attending this meeting with you an attorney?

 *

Are you or any person attending this meeting with you an attorney?(Select an Answer) Yes No

Please provide the meeting details below. The more information you provide the better. *All Fields are Required

5

With which elected official are you requesting to meet?

 *

With which elected official are you requesting to meet?

Harold Weinbrecht, Mayor

Lori Bush, At-Large Representative

Carissa Kohn-Johnson, At-Large Representative

Jennifer Robinson, District A Representative

Jack Smith, District C Representative

Sarika Bansal, District D Representative

Michelle Craig, District B Representative

6

Please describe the purpose of this meeting, including specific details.

 *

Please describe the purpose of this meeting, including specific details.

7

What are you expecting of the elected official as a result of this meeting?

 *

What are you expecting of the elected official as a result of this meeting?

8

Is this request regarding a Council meeting agenda item?

 *

Is this request regarding a Council meeting agenda item?(Select an Answer) Yes No

9

Have you spoken with a Town of Cary staff member regarding the subject of the meeting? If so, please include their name(s).

 *

Have you spoken with a Town of Cary staff member regarding the subject of the meeting? If so, please include their name(s).

10

Have you spoken with any other Councilmembers about this subject? If so, which Councilmember(s)?

 *

Have you spoken with any other Councilmembers about this subject? If so, which Councilmember(s)?

11

If this meeting needs to occur before a certain day, please indicate that date below.

 *

If this meeting needs to occur before a certain day, please indicate that date below.

12

How much time should be allocated for the meeting?

 *

How much time should be allocated for the meeting?

13

How many people (including their names) will attend with you?

How many people (including their names) will attend with you?

14

What is your general availability and flexibility?

 *

What is your general availability and flexibility?

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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