Required fields are marked with asterisks (*)

Delegation Request Form

Request to Appear as a Delegation at a Town of Ingersoll Council Meeting

Name of Delegate(s) – include title/position, if applicable:

Street Address:

Town:

Postal Code:

Email Address:

Phone Number:

Meeting Date:

Delegation Status:

Attending as an individual

Representing a Group/Organization/Business

Name of Group/Organization/Business:

Subject:

Details of the purpose of Delegation:

Will a PowerPoint presentation be made?

Yes

Will you be attending this meeting in-person or online?

In-person

Online/remote

Do you or any members of your party require accessibility accommodations?

Yes

I acknowledge that the Procedural By-Law permits 10 minutes for delegations:

Yes

I acknowledge that all presentation material must be submitted to the Clerk’s Office (clerks@ingersoll.ca) by 4:00 p.m. the Wednesday before the Council Meeting Date:

Yes

Please be advised that submitting a delegation request is not a confirmation that the delegation has been confirmed. Should your delegation be confirmed, please be advised that delegation information and presentations submitted are considered to form part of the public record.

Notice of Collection

Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), including (but not limited to), names, addresses, contact information, comments, is collected under the authority of the Municipal Act, 2001, and in accordance with MFIPPA and all other relevant privacy legislation. Personal Information will be used by Town of Ingersoll Staff to respond to inquiries received, action service requests and provide status updates. Questions regarding this collection, use, and disclosure of this personal information may be directed to the Clerk at Danielle.richard@ingersoll.ca or (519) 426-5870 x 6229.

Form Builder

Delegation Request Form