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Elected Official Meeting/Appearance Request

  1. This form is used to request a meeting or appearance by City of Burlington's elected officials.

  2. Individual requested to attend event or meeting, or ribbon cutting*

    Please check all that apply below.

  3. Please provide at least two dates and times for the requested meeting.

  4. Provide suggested location, for example the Municipal Building, a public space, etc. Please provide the address of any location other than meetings at City of Burlington Municipal Building.

  5. Who will be attending the meeting or if this is an event what is the estimated attendance.

  6. Briefly explain the purpose or goals of the meeting. If requesting the elected official for meeting, please include topic(s) of discussion or questions of specific interest. If requesting the elected official to speak at an event, please include the topic(s) you wish for them to speak about.

  7. For any questions regarding this form you may reach out to the City of Burlington Administration Office at 336-222-5020

  8. Leave This Blank:

  9. This field is not part of the form submission.