Prescott Heritage Committee

Prescott Heritage Committee

Application Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred Method of Contact
Skills & Qualifications: (Please list any relevant experience)
Interests & Hobbies
Are you the owner or tenant (or spouse of an owner or tenant) of property in the Town of Prescott?
Are you 18 years of age or older?
Are you legally entitled to work in Canada?
Notice of Collection:

Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) is collected under the authority of the Municipal Act, 2011, and in accordance with the provisions of the MFIPPA. Personal information on this form will be used to assess the applicant's eligibility for volunteer positions or qualifications for appointment to the Prescott Library Board. At no time will your personal information be disclosed without your express written consent. Questions regrading the collection, use and disclosure of this personal information may be directed to the Freedom of Information Coordinator, Clerk's Office, 360 Dibble St West, Prescott, ON K0E 1T0, 613-925-2812.
Declaration:
Should be Empty: