Expression of Interest: Present to Council

Expression of Interest: Present to Council
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownState / Province

Postcode
Contact Number*
Email Address*
Presentation Title *
Please use a title that summarises the subject matter.
Presentation Summary*
Briefly outline what the presentation is about and provide details of the presenter or the group being represented. Follow with a short summary of the presentation that clearly states what you are seeking from Council.
Detail and Background*
Enter a summary of the detail and background to the presentation.
Name of Organisation (if applicable)
Names and Titles of those attending (max. four people)*
Include the name of the presenters and the represented organisation or association, if applicable.
When would you like to request to present?

4 February - Leongatha4 March - Venus Bay1 April - Leongatha6 May - Leongatha3 June - Loch5 August - Leongatha2 September - Port Welshpool7 October - Leongatha4 November - Leongatha2 December - Leongatha
Do you have supporting documentation (PowerPoint presentation, handout etc.)? If so, they must be included with this Expression of Interest and be clear and legible.*

YesNo
Upload supporting documents to your presentation below.

Upload a File
Please upload all documents that you wish Councillors to consider relating to your matter. This may include a written submission, a PowerPoint presentation, handout etc. Cancelof
Does your presentation relate to a Planning Matter?*

NoYes, I am in support of the Planning MatterYes, I am in opposition to the Planning Matter
Before you submit this form, please ensure your Expression of Interest is:
- Clear and legible.
- Submitted with adequate supporting information.
- Related to a matter within the duties, functions and powers of Council (excluding operational matters).
- Not defamatory, indecent, abusive, offensive, irrelevant or objectionable in language or substance.
- Relevant to a matter of public interest or community benefit.
Once this form is submitted, an automatic acknowledgement will be emailed to the recipient.

Further correspondence of meeting times will be confirmed by Council’s
Governance team via the email address entered on this Expression of Interest form.
Please indicate that you accept the above criteria:*

I accept
Should be Empty: