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2. First Name
3. Last Name
4. Organization
6. Date
   Date

   Date
7. Your phone number*
8. Your email address
10. Details of Agenda Item Request
12. Choose Council Meeting Date (2nd & 4th Tuesday of each month)
    Choose Council Meeting Date (2nd & 4th Tuesday of each month)
13. Choose Alternate Council Meeting Date
    Choose Alternate Council Meeting Date
14. Upload any documents for consideration in this agenda item request.
16. Town Staff Notice
    Departments must provide Council supporting information in computer readable form. The order of preference is (1a) Word, (1b) Excel, (2) PDF, or finally, and least acceptable, image form. To submit paper only documents, the department head must authorize not using computer materials.
18. Please indicate if supporting documentation is attached:
19. Check one*

    1. Yes
    2. No
21. Pending Approval
    Your agenda request will be submitted to the Town Manager and Mayor for approval. You will be notified of their decision by the Town Clerk. You may contact the Town Clerk at phone 575-534-6346 or by email at townclerk@silvercitynm.gov. Thank you.
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field