Request for Delegation Form
A. Person Requesting Appearance
Full Name/Affiliated Organization
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Person(s) to Appear:
1. Full Name/Affiliated Organization
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
2. Full Name/Affiliated Organization
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Date
-
Day
-
Month
Year
Date
Alternate Date
-
Day
-
Month
Year
Date
General Outline of Subject Matter and Request to Council (10 Minutes allotted for Delegation)
B. Flag Raising Request (If not applicable, proceed to section C.)
Name of Flag(s)
If multiple, separate with a comma.
Date(s) of Flag(s) Raising: From
-
Day
-
Month
Year
Date
To:
-
Day
-
Month
Year
Date
Name of individual dropping off the flag(s) to the Municipal Centre (Reception) before the Council Meeting:
First Name
Last Name
Flag(s) Drop-Off Date:
-
Day
-
Month
Year
Date
Drop-Off Time
Hour Minutes
AM
PM
AM/PM Option
C. Presentation Material
PowerPoint presentations are preferred. Please submit presentation material no later than one week prior to the meeting to allow the Clerk’s Office sufficient time to prepare the agenda and coordinate a test run if necessary. Please e-mail the presentation material to: clerk@northgrenville.on.ca
Presentation material?
Yes
No
D. Reminder
Scheduling of the delegation will be at the discretion of the Clerk and will be confirmed. There are no guarantees that the requested date will be approved as prior commitments may take precedence. As such, alternative dates may be canvased by the Clerk. Submission of this form does not guarantee approval of your request for a delegation. All information submitted is considered public information and is therefore subject to full disclosure, under the Municipal Freedom of Information and Protection of Privacy Act.
I have read and understand the above statement.
Yes
No
Submit
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