Required fields are marked with asterisks (*)

Delegations Form

Please complete this form if you wish to speak at a Council meeting or Committee meeting.

Presentation documents if any, must be made accessible by following our presentation guidelines.

The Municipality of Clarington makes a video record of Committee and Council meetings. If you make a delegation/presentation to a Council or Committee, the Municipality will be audio recording you and will make the recording public by publishing the recording on the Municipality’s website.

Personal information is collected on this form under the authority of Section 238 of the Municipal Act and shall be used for the purpose of corresponding with the delegation relating to matters before Council or Committees. Questions about this collection can be directed to the Municipal Clerk, 40 Temperance Street, Bowmanville, ON L1C 3A6 or by phone at 905-623-3379.

Subject

Action requested of Council

Date of meeting

Summarize your delegation

Have you been in contact with staff or a member of Council regarding your matter of interest?

Yes

Report number (if known)

Correspondence number (if known)

Will you be attending this meeting in person or online?

In person

Online

First name:

Single/Last name

How to pronounce your name:

Firm/Organization (if applicable)

Job title (if applicable)

Address

Town/Hamlet

Postal code

Email address:

Phone number

Alternate phone number

Add an additional speaker Remove

Do you plan to submit correspondence related to this matter?

Yes

Do you plan to submit an electronic presentation (i.e. PowerPoint)? If yes, the file must be submitted to the Municipal Clerk’s Department by 2 p.m. on the Friday prior to the meeting date.

Yes

I acknowledge that the Procedural By-law Permits seven minutes for delegations and five minutes for Public Meeting participants.

Yes