REQUEST TO SPEAK AT PUBLIC HEARING i <br />The purpose of this form is to make sure that people wishing to testify have an opportunity to do so, as well as to make sure that <br />the names and mailing addresses of those testifying are correct and become part of the record. Anyone wishing to testify is re- <br />quested to fill out this form. People speaking at the hearing as well as those submitting written testimony will be notified of the <br />decision by mail. <br />PLEASE PRINT CLEARLY <br />Today's Date: March 7, 2017 <br />Name: CA4US roeec <br />Mailing Address: EGI~,n~`atZ.- fjf 7 yy3 <br />Agenda Item/Application Name: UGB Adoption Package <br />PLEASE CHECK ONE OF THE BOXES BELOW <br />❑ Speaking in favor <br />❑ Against/Opposed <br />Neutral (neither in favor or opposed) <br />❑ Do not wish to speak but would like to be notified of the decision <br />Please return completed form to City of Eugene staff. <br />