Required fields are marked with asterisks (*)

Request to Appear as a Delegation Form

Topic

Meeting Date

Who are you representing

Myself

My Business

Other

Reason for Appearing

Do you have material to distribute at the meeting

Yes

Do you have a copy of your notes and/or presentation to attach?

Yes

Please Note: All material to be distributed at the meeting and/or any electronic presentations must be received by the Town Clerk no later than 12:00 PM (noon) the Tuesday prior to the meeting. Materials must follow the guidelines provided on the back on this form.

Contact Information

Name

Address

Phone Number

E-mail Address

I hereby consent to the release of my personal contact information for the purposes of the agenda preparation and meeting

I Agree

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O c.M.56 as amended and will be used to document delegates names, addresses, and key messages for Advisory Committees and Council. Inquiries may be directed to the Town Clerk by telephone at 613-623-4231 ext. 1818 or by email at clerks@arnprior.ca.