Delegation Request Form

The completed form must be submitted to the Clerk's Office by 12:00 noon on the Friday prior to the meeting at which you wish to appear. For more information please view the Council delegation procedure and guidelines.

Name:

Organization Name (if applicable)

E-mail:

Address:

City/Town:

Postal Code:

Telephone:

I acknowledge that my presentation must not include statements or materials that are:

Intended for the sole purpose of generating publicity
Related to litigation or potential litigation or to any matter which is currently before any court or administrative tribunal affecting the Town of Grimsby
Disrespectful towards Committee/Council members, Town employees or any other member of the community

I agree

Yes

No

Topic not included on a meeting agenda:

To speak to Committee/Council about a topic that is not part of an upcoming agenda, please email clerks@grimsby.ca and include:

a description of your concern
the action you would like Committee/Council to consider

Staff will contact you when a decision has been made.

Committee/Council Date:

Agenda Item Title:

I am presenting new information only:

Yes

No

The key points of my deputation are as follows:

I would like the Committee/Council to take the following action:

Please attach a copy of your presentation.

Browse…

Allowed extensions pdf, doc, docx, jpeg, powerpoint,ppt,pptx

* Written comments will form part of the public record. We post these documents online, so the listing of your name in connection with an agenda item may be indexed by search engines like Google.

I acknowledge I have 10 minutes to delegate:

Yes

No

I give permission to be audio and video recorded on the Town of Grimsby's livestream:

Yes

No

Do you require accessible accommodation to participate:

Yes

No

Date:

Signature:

Clear

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