You must have JavaScript enabled to use this form. 1 Start 2 Complete 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 * City/Town/Village * Province * Postal Code * Email Address: * Telephone Number * Preferred Meeting Month (A staff member will connect on a meeting date) * - Select -JanuaryFebruaryMarchAprilMayJuneJulySeptemberOctoberNovemberDecember 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? * No (For Information Only) Yes (Action is Required) 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. Leave this field blank