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2. First Name*
3. Last Name*
5. How Would You Like To Be Contacted?

   1. Phone
   2. Email

   Please provide information on how you may be reached if you are wanting someone to contact you.
7. Phone #*
8. Email*
10. Who Do You Want to Contact?*

    Select All That Apply

    1. Mayor Ruben Gonzalez
    2. District 1 Alderman Miguel Aguirre
    3. District 2 Alderman Richard Hughes
    4. District 3 Alderman David Emery
    5. District 4 Alderman Michael Rodriguez
    6. District 5 Alderman Charles Cate
12. What Would You Like to Say?
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14. 1. Receive an email copy of this form.
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