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2. First Name
3. Last Name
5. Email
6. Phone
8. Address
10. City
11. State
12. Zip Code
14. Comments
16. Would you like to be contacted regarding your comments?

    1. Yes

    1. No
18. How do you prefer we contact you?

    1. Email
    2. Phone
    3. Other
19. Please List
21. Please be advised that Wellington is a public entity subject to Florida’s broad public records law under Chapter 119, Florida Statutes. Most written communications, including email addresses, to or from Wellington employees and elected officials regarding city business are public records and are available to the public and the media upon request. Your email communications may therefore be subject to public disclosure. If you do not want your email address to be subject to disclosure as a public record, please do not send electronic mail to Wellington. Instead, contact the city by telephone at 561-791-4000.
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23. 1. Receive an email copy of this form.
24. Email address

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