REQUEST TO ADDRESS THE BOARD OF EDCUATION

I request permission to address the Plainview Board of Education on the following topic:
 
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                (Date)                                                                                     (Name)
 
 
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Date Requested to Speak                                                                  (Street Address)
 
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Date Form Completed                                                                   (City)                      (State)                    (Zip)
 
 
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                                                                                                                (Telephone)
 
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                                                                                                                (Group Represented)