Form Center

2. Name of Requesting Member*
4. I hereby request to attend the following meeting(s) via electronic participation*
6. Date(s)*
7. Time*
9. Pursuant to 520 ILCS 120/7 of the Open Meetings Act, I hereby request to electronically attend the referenced meeting(s) due to the following*

   1. Personal illness or disability
   2. Employment purposes or other City business
   3. Family emergency or other emergency
11. During the meeting, I may be reached at the following phone number*
13. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
15. Electronic Signature
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field