Delegation Request Form

Written delegation requests received ten (10) calendar days before a scheduled meeting will be listed on the agenda. A delegation is permitted to speak for five (5) minutes, except by leave of the Board or Committee Chair.

Your request will be reviewed and you will be contacted to confirm your delegation prior to the meeting date. For more information, see the Governance page and The Halton Region Conservation Authority General Membership By-law.

Which Conservation Halton Board or Committee do you wish to address?

Please select the date of the meeting at which you wish to address the Board or Committee:

Date

Delegate Name

First NameLast Name

Are you making a delegation as an individual or on behalf of an organization/group?

Note: If you are not representing an organization or group and are making a delegation as an individual, you will be listed on the agenda as representing yourself as a resident.

Name of Organization/Group:

Position/Title (if applicable):

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Phone Number Extension (optional)

Address

Street Address

Street Address Line 2

MunicipalityProvince

Postal

Is the topic of your delegation a matter related to the mandate of Conservation Halton?

Please Note: Delegations are only permitted to speak on matters related to the mandate of Conservation Halton.

Reason for Delegation Request:

Please include the topic/agenda item to which you intend to speak and a statement about your position on the matter.

Have you made a delegation to the Conservation Halton Board or Committees on this topic in the past?

What is the name/title of your delegation? (As it will appear on the agenda.)

Have you discussed this matter with Conservation Halton staff?

Please provide the staff name or department:

Will there be a formal presentation and/or accompanying materials in support of your delegation?

Please Note: Copies of supporting materials will be published on the Conservation Halton website as part of the meeting agenda. Supporting materials not submitted with your delegation request cannot be part of your delegation; all materials must be included with your written request prior to the submission deadline. If possible, please ensure that your presentation is compliant with the requirements of the Accessibility for Ontarians with Disabilities Act.

Please upload your delegation materials:

I have reviewed and agree to comply with the provisions and requirements for delegations outlined on the Governance webpage and The Halton Region Conservation Authority General Membership By-law, including the Code of Conduct.

Pursuant to the Municipal Freedom of Information and Protection of Privacy Act, the personal information contained on this form is collected under the authority of the Conservation Authorities Act R.S.O 1990, c. 27 s. 21. (1). The information provided on this form will be collected and maintained for the purpose of sending correspondence relating to matters before the Conservation Halton Board and may become part of the public record.

Questions about the collection of information can be directed to the Freedom of Information Coordinator, Office of the President & CEO, 2596 Britannia Road West, Burlington, Ontario, L7P 0G3, 905-336-1158 ext. 2236, admin@hrca.on.ca.

Delegation Request Form

DELEGATION REQUEST

NOTICE OF COLLECTION