Delegation Request Form

A person wishing to make a delegation on an agenda item shall submit a completed online or hard copy delegation request form, which shall include any presentation material the person intends to rely on, to the Clerk in accordance with the following timelines:

(a) in the case of a Committee meeting, no later than twenty-four (24) hours prior to the start of the meeting; and

(b) in the case of a Council meeting, no later than twenty-four (24) hours prior to the start of the meeting (typically 6:30 p.m. Sunday).

For more information, please refer to Section 7.5 of the Town's Procedural By-law 20-65.

Please note:

Matters not listed on an agenda must be submitted at least 7 days before the meeting.
The Clerk has discretion to determine the meeting at which the delegation shall be made.

Name:

Name of Committee you wish to speak to (please note the Clerk has discretion to determine the meeting at which the delegation shall be made):

Organization Name (if applicable)

E-mail:

Address:

City/Town:

Postal Code:

Telephone:

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

Any matter matters which have been previously decided upon by Council within the last six (6) months.
Litigation or potential litigation, including those matters which are before and under the jurisdiction of any court or administrative tribunals.
Matters which are outside the jurisdiction of the Town.
Notices of Motion (provided that delegates will have an opportunity to speak at the subsequent Committee or Council meeting when that item will be discussed).
Previous Minutes and Board Minutes listed on the agenda.
By-laws on the agenda.
Closed Session items.
Reports filed by the Integrity Commissioner.
Relief from the User Fees and Charges By-law or any requests relating to tax bills, water bills, or Town-issued offence notices, administrative penalties and/or Orders.
Disrespectful remarks towards Committee/Council members, Town employees or any other member of the community.

I agree

Yes

No

Agenda Item Title:

I am presenting new information only:

Yes

No

Speaking notes for my delegation are as follows (if you have already delegated, please ensure you are only providing new information):

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

Please attach a copy of your presentation. A presentation/slideshow is not required, but if you wish to present with one it must be submitted no later than 24 hours before the meeting or it will not be permitted.

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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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