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2. 
3. CONTACT MY COUNCILPERSON
5. Any person wishing to contact their respective Councilperson may do so by completing the form and submitting it via the City of Fairbury's website.
7. Please check the box of the Councilperson you would like to contact*

   1. Ward 1 - Kelly Davis
   2. Ward 1 - Tim Polson
   3. Ward 2 - Brad Kuzelka
   4. Ward 2 - Brian Schmidt

   1. Ward 3 - Rick Carmichael
   2. Ward 3 - John Ebke
   3. Ward 4 - Doug Brown
   4. Ward 4 - Phil Rogge
9. Date*
10. Name*
11. Street Address*
13. Telephone Number*
14. Email Address
16. Description:*
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

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