Required fields are marked with asterisks (*)

Request to Speak at a Meeting

If you are interested in appearing in person at a Council or Standing Committee meeting to present information or an opinion on a matter, please fill in the form below.

Full Name

Phonetic Pronunciation of Name

Pronouns

Mailing Address

Email Address

Phone Number

Contact Preference

Telephone

Who are you representing?

Myself

Group or Organization

Another Individual

Township/Town/City

Postal Code

Will you require an accessibility accommodation?

Yes

Presentation Details

Requested Meeting Date

Is this delegation request in relation to an agenda item?

Yes

How would you prefer to attend this meeting?

In-Person

Online

Subject of Delegation

Have you presented on this topic before?

Yes

What is your position on this issue/agenda item?

In Favour

Opposed

Other

Please provide the key points of your presentation.

Are you expecting an action and/or recommendation from Council in response to your presentation?

Yes

Do you have an electronic presentation?

Yes

Please provide any additional comments you may have in regards to your delegation request.

Acknowledgements and Consent

I understand that I only have ten (10) minutes to present.

I understand that I can only address Council on the same issue once.

I understand that inappropriate behaviour, action and/or treatment of Council and/or staff will not be permitted before, during or after my presentation.

I understand that delegations are approved on a first come first serve basis, with a maximum of four being allowed per meeting, and that submission of a delegation request does not guarantee a spot at my preferred meeting.

I understand that I must present concisely and remain on topic throughout the entire presentation.

I understand that the Township of West Lincoln Council and Committee meetings are publically broadcast on the internet and that my information will become part of the Township's public record.

I understand that personal information on this form is collected under the authority of Section 6 of the Township of West Lincoln's Procedural By-Law for the purpose of contacting individuals and/or organizations requesting an opportunity to appear as a delegation before a Committee or Council.

Signature

Clear

Date

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Request to Speak at a Meeting

Presentation Details