Delegation Form

Please read the Delegation Information Sheet. If there is further information to be presented to Council, please attach it to this sheet.

Download: Delegation Information Sheet

Please note that this form and any information provided may be attached to the agenda and circulated publicly (unless otherwise requested). The form must be completed prior to 4pm on the Wednesday preceding the meeting you wish to speak at.

Contact Information

* First Name

* Last Name

* Email Address

* Phone #

Fax #

Meeting Information

* Date of meeting you wish to speak at

Month	Day	Year

* Name of Organization/Person

* Name of Speaker(s)

* Topic

* Is there a specific request that Council will be asked to consider? If yes, please provide the request.

* Do you require any special equipment (ie: PowerPoint Projector/Overhead Projector Screen)?

Yes

If yes, please indicate what is required

NOTE: We will try out best to supply you with whatever equipment is necessary but we cannot guarantee what will be available. You will be advised before your delegation what is available.

Attachment 1

Attachment 2

Attachment 3

* I have read and understand the Delegation Information Sheet and understand that the information contained on this form, including any attachments, will become public documents and listed on Township Meeting Agendas and posted to the Township’s website.

I agree

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