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Online Delegation Registration Form

By submitting this form you are requesting to appear as a delegation before one of the Standing Committees of Council or before City Council.  Before proceeding please refer to the meeting calendar and confirm both the meeting date and that the item you wish to speak to is on the agenda. If you have questions, please contact one our Committee Assistants at 905-335-7600 ext. 7855 or ext. 7458.


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Topic:
Name of Committee:
Date of Meeting:
Pick date
Agenda Item No. (if known)
Representing:
SelfOther
If other, please specify who you are representing:
Speaking:
If other, please specify your reason for appearing/additional comments:
Do you have material for distribution at the meeting?
YesNo
If yes, please specify:
Do you have a copy of your notes/presentation to attach?
YesNo
Attachment (pdf, max. 5MB):
Name:
Home Address:
Name of Organization (if applicable):
Organization Address (if applicable):
City:
Postal Code:
Residence Telephone:
 
Business Telephone:
 
Email Address:
 
I hereby consent / do not consent to the release of my personal contact information (mailing address and/or e-mail) in the relevant meeting agenda, delegation list, and minutes.
ConsentDo not Consent
 

Personal information on this form is collected under the authority of the Municipal Act, S.O. 2001, c.25 and will be used to document delegates names, addresses, and key messages for Standing Committees and Council. The disclosure of this information is governed by the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.M. 56. Inquiries may be directed to the City Clerk at 905 335-7698, email: cityclerks@burlington.ca.

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