Delegation Request Form

Personal Information on this form is collected under the authority of the Municipal Act 2001 P.S.O. c45 and may be included in Agendas and Council Meeting minutes, both of which become part of the public record and posted on our municipal website.

First Name

Last Name

Are you representing a group?

Yes

No

How would you like to be contacted?

Email

Phone

Subject to Discuss

Have you appeared before Council in the past to discuss this issue?

Yes

No

Will you have an oral or written presentation?

Oral

Written

Do you have any equipment needs? (projector, easel, etc)

Yes

No

Do you require a copy of the staff report?

No

Yes - I will pick up the report

Yes - please email the report

How would like to attend the Council meeting? Please be advised that the method selected for attending the Council meeting may not be changed.

Electronically via Zoom (must have access to a computer or tablet with internet service or smart phone and will be required to join with both audio and video)

In-Person at the Leamington Municipal Building Council Chambers (111 Erie Street North, Leamington)

Date you would like to appear before Council

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Delegation Request Form

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