Delegation Request Form

This form must be completed and submitted to the Clerk of the Town of Kingsville by all persons wishing to address Council at a scheduled meeting of Council. Please refer to the Delegation Information Sheet for additional information about appearing before Council.

Please note that personal information collected in this form may be included in the Council Agenda package and/or the Council Meeting Minutes, both of which are part of the public record and posted on the Municipal website.

Main contact name

Address

City

Main contact phone number

Email address

Are you representing a group?

Yes

Will other group members be attending?

Yes

Date you wish to appear before Council

Please provide a brief summary of the issue(s) you will be presenting to Council

Have you appeared before Council on this issue before?

Yes

Have you been in contact with staff on this issue before?

Yes

Will you be providing any handout material to aide your presentation?

Yes

Do you have any equipment needs for your presentation?

Yes

Do you have any special needs when presenting?

Yes

Date

Signature

Clear

The personal information contained in this Form is collected pursuant to the Municipal Act, 2001. Any personal information will be used to properly place the item/issue you wish to discuss in Council's Agenda package. This information will become part of the public record, unless you expressly request the removal of your personal information. Questions about the collection of this information may be directed to the Legislative Services Department.

Delegation Request Form

I Want To...

Apply or Register

Pay

Report