Delegation Request Form

This form must be completed and submitted to the Clerk of the Town of Essex by all persons wishing to address Council at a scheduled meeting of Council. Delegation requests must be submitted by 2:00 p.m. on the Tuesday prior to the scheduled meeting. Please refer to our online Community Calendar at www.essex.ca for scheduled Council meetings.

Presentations to Council are limited to 5 minutes per person to a maximum of 10 minutes for a group of two persons or more.

Personal information that you provide on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Please note that this form, if approved, will appear in the published Council Agenda and may be included in the Council Meeting minutes, both of which become part of the public record and are posted on our municipal website.

Name

Date of Request

Are you representing a group? Are you representing a group?

Yes

Name of Group (if applicable)

Provide details on the issue(s) you wish to present to Council and any actions you will be asking Council to take.

Have you consulted with Town staff on this issue? Have you consulted with Town staff on this issue?

Yes

If you've consulted with Town staff, please provide the names of staff members you've talked to and the details of those discussions.

If this is a property matter, are you an owner? If this is a property matter, are you an owner?

Yes

Not applicable

Have you appeared before Council in the past regarding this issue? Have you appeared before Council in the past regarding this issue?

Yes

If you've appeared before Council in the past on this issue, please tell us the year in which you appeared.

Will you have written or printed materials to distribute? If so, please submit 12 copies of printed materials to the Clerk before the meeting.

Yes

Will you be delivering an electronic presentation that requires access to a computer and software? If so, please submit your presentation on CD, DVD or flash drive by noon on the Friday before the Council meeting.

Yes

Please describe any special needs you may have for your presentation.

Your Address or Group Contact Address (full mailing address including postal code)

Your Phone Numbers

Home

Work

Cell

Email Address

Name and address of all representatives attending, including their positions