Sign Up to Speak at a Planning Commission Public Hearing This form must be submitted no later than 4 p.m. on the day of the scheduled hearing to allow enough time to arrange your session. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email Speaking RequestPersons speaking for themselves are allowed to speak for three (3) minutes. Public speakers representing groups (civic associations, building tenants, ad hoc coalitions, County advisory commissions and others) are allowed to speak for five (5) minutes.I am speaking for*MyselfAn OrganizationNumber of Minutes*3 minutes2 minutes1 minutesOrganization Name*Number of Minutes*5 minutes4 minutes3 minutes2 minutes1 minuteSubject/Agenda Item You Will Be Speaking On*Please be aware that information submitted through an Arlington County Government website is considered to be a Public Record under the Virginia Public Records Act and may be subject to release by the County in response to a request made under the Virginia Freedom of Information Act.Do not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services.Arlington County may withhold your name and contact information in accordance with the Virginia Freedom of Information Act. Please indicate, by checking the box below, if you would like for the County to seek to keep this information confidential.Do Not Disclose Opt-Out Please do not disclose my name and contact information in response to a request under the Virginia Freedom of Information Act. I recognize that the County cannot guarantee the confidentiality of my name and contact information but ask that it do so to the extent permitted by law. PhoneThis field is for validation purposes and should be left unchanged.