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MARTINSVILLE GOVERNMENT ACCESS CHANNEL <br /> BULLETIN BOARD MESSAGE FORM <br /> <br /> Form may be copied. Please use separate form for each entry. <br />Department/Agency Submitting Item <br />Item Requested to appear: <br /> <br /> Event: <br /> <br />Date: <br /> <br />Time: <br /> <br />Place: <br /> <br />Contact Info: <br /> <br />Sample Item: <br /> <br />Martinsville City Council Meeting <br />Wednesday, June 21 st <br />7:30 p.m <br />Council Chambers, 2nd Floor, City Municipal Building <br />Contact: City Manager's Office, 656-5180 <br /> <br />Signature of Department/Agency Head or Designee: <br /> <br />Date Form Submitted to the Public Information Officer: <br /> <br />The Public Information Officer may edit entries for format reasons. If extensive changes will be required, <br />the submitting department/agency will be contacted. Please return forms at least ten (10) business days <br />prior to event date. Submit to: <br /> <br /> Public Information Officer <br /> 2nd Floor, City Municipal Building <br /> 55 West Church Street <br /> Martinsville, VA 24112 <br />Phone: 656-5386 Fax: 656-1086 <br /> <br />For Internal Use Only <br /> <br />Date form received ..................... <br />Received by <br />Approved Not approved <br />If not approved, reason why: <br /> <br />Date returned to department: .............. <br /> <br /> <br />