431 College Road Support Form

431 College Road Support Form

Thank you for supporting seniors care in Qualicum Beach! Please fill out this form to have your voice heard.
I fully support a four storey, 141-suite, assisted living and long term care home at 431 College Road, Qualicum Beach. This project will provide much-needed housing and care services for seniors in our community. I urge Council to approve this project for the benefit of current and future residents of the Town of Qualicum Beach.

By signing this form I consent to having my name, signature, and support letter submitted to the Town of Qualicum Beach in connection with this project.
Supporter Name*

First NameLast Name
Signature*
Date*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional comments
Please share any thoughts or comments on the project.
Reminders: By submitting this form, you agree that the information provided is accurate and truthful to the best of your knowledge. Please provide relevant and accurate information to support the cause.
Please verify that you are human*
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