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2. First Name*
3. Last Name*
5. Board-Commission Name You Serve On (member or staff liaison/support for)*
   -- Select One --Planning and ZoningTown Council
7. Video Conference Meeting Participation Preference (with the current situation in mind, select one of the options below):*

   1. Attend the meeting off site in my home or other remote location (not Town Hall)
   2. Attend the meeting at Town Hall (recognizing you would most likely be in a conference room in the building because only 1 person can be in JSH for audio purposes and to maintain social distancing)
   3. Attend the meeting via my office (staff)
9. Do you currently have the ability to video conference remotely?

   1. Yes (have webcam and microphone)
   2. No (would need a Town provided webcam)
   3. Not sure
10. Comments
    Include any comments regarding your comfort level in using a video conference program or additional information that might be helpful (i.e. currently using for work, familiar with Zoom, etc.)
12. Comments (any additional information you would like to make us aware of)
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13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

* indicates a required field