Required fields are marked with asterisks (*)

Township of Essa Delegation Request Form

Please complete and submit in this form online if you would like to speak or make a presentation to Council during Committee of the Whole.

Mandatory fields are marked with an asterisk (*).

Name(s) of person(s) to appear before Council:

Email Address

Title and Organization (if applicable)

Phone Number

Mailing Address

Name(s) of person(s) appearing before Council (if different than above)

Preferred Date for Presentation:

Alternate Date for Presentation:

Please provide the general outline of the subject matter for your presentation (Please Note: A maximum of 10 minutes is allotted for your delegation)

Are you submitting a letter with your request?

Yes

Please advise if you require the use of a projector

Yes

Please Note:

Those wishing to conduct a presentation must provide an electronic version of their presentation in Microsoft PowerPoint (at a minimum 7 days in advance of the meeting) to the Clerk's Office, otherwise the presentation will not be permitted to take place.
A written and signed letter outlining the subject matter of your delegation must be provided to the Clerk's Office by 4:00 pm on the Wednesday PRIOR to the meeting.
Additional material may be circulated/presented at the time of the delegation.
Scheduling of your delegation will be at the discretion of the Clerk, and in accordance with the Township's Procedural By-law.
There is no guarantee that by requesting a certain date, that your delegation will be approved.
Submission of this form does not guarantee the approval of your request.
All information submitted will be considered as public information and therefore subject to full disclosure under the Municipal Freedom of Information and Protection of Privacy Act.

Are you submitting your letter / presentation with your application today?

Yes

Please upload letter / presentation if you are submitting it with your application today

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Date of Application

Signature of Applicant

Clear

Personal information contained in this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), and will be used only for the purpose for which its collection was intended. Questions about this collection should be directed to the FOI Coordinator at the Township of Essa.