Mayor Carl A. Redus, Jr.

Office of the Mayor

City of Pine Bluff

200 East 8^th Avenue, Suite 201

Pine Bluff, Arkansas 71601

870-543-1855 (Phone)

870-543-1801 (FAX)

Mayor’s Office Appointment Request Form

Appointment requested by ______________________________________________________

Organization represented (if any) _________________________________________________

Please provide the following where applicable and check your preferred method of response:

Work Phone _______________________________________________________________

Cell Phone _______________________________________________________________

Home Phone _______________________________________________________________

FAX _______________________________________________________________

E-mail _______________________________________________________________

In the space provided below, please state the nature of your proposed appointment with the Mayor, along with any other relevant comments:

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