Skip to form

City of Charlotte

corporatecommunications1@ci.charlotte.nc.us

600 East Fourth Street, , Charlotte, NC, 28202, US

704-336-7600

District 5 Representative Marjorie Molina Meeting Request Form

Thank you for contacting the Office of District 5 Representative Marjorie Molina. In an effort to expedite your request, we ask that you answer the below questions completely. Requests will not be reviewed prior to receiving complete information. Meeting requests should be made at least four weeks prior to the start date.

Completion of this form does not guarantee acceptance or confirmation of request. You will be contacted within ten business days.

Full Name

Full Address

if "Other"

Preferred Date & Time

Date Picker

1st Alternate Date & Time

Date Picker

2nd Alternate Date & Time

Date Picker
Be sure to verify that you are not a robot by using the Captcha tool at the below.
Having reCaptcha issues? Click here to reset the widget.