Request for Deputation

I am requesting to speak:

On my own behalf

On behalf of a group/ organization/ association

Name(s) of Speaker(s) and Group/Organization/Association (to be listed on the agenda)

Address

Suite

City/Town

Province

Postal Code

Your Email

Phone Number

Preferred Meeting Month (A staff member will connect on a meeting date)

Brief Statement of Purpose of Deputation

Have you discussed this matter with Town staff?

Yes

No

If yes, which department and staff member(s) have you spoken to?

Are you requesting a specific action or request for Council?

Yes

No

Yes indicates action is required, No indicates this request is for information only.

If yes, please outline your specific action or request of Council

Please check that you have read and agree to the following:

All presentations will be submitted in PowerPoint or PDF format by the date provided by the Clerk's Department and made available to the public following the meeting

The allotted time for deputation is ten (10) minutes including a question period

USB devices are not permitted

Collection of Information

I agree

Personal information on this form is collected under the legal authority of the Municipal Act, S.O. 2001, c.25, as amended. The information is collected and maintained for the purpose of creating a record that is available to the general public pursuant to Section 27 of the Municipal Freedom of Information and Protection of Privacy Act.