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Delegation Request Form

The Council of the Township of Asphodel-Norwood welcomes all visitors, residents, and those who have business with the Township to its meetings.

Any delegation wishing to make verbal presentation to Council must complete this Delegation Request Form and submit to the Clerk no less than six (6) days prior to the meeting. The form must include a sufficiently clear statement of the issues or matters to be dealt with at Council. All supporting delegation materials/presentations must also be submitted to the Clerk no less than six (6) days prior to the meeting.

Any delegation that has previously appeared before Council regarding the same matter will not be permitted to readdress Council within six (6) months of the initial visit, unless in the opinion of the Clerk there is new information that is pertinent to the matter.

Delegations shall be limited to ten (10) minutes to address Council and will consist of a maximum of two (2) speakers.

Delegations shall be limited to three (3) per meeting.

Please note: By completing this Delegation Request Form, it will become a part of the public agenda along with any personal information and materials submitted as part of the presentation. All meetings are recorded and uploaded to the Township's YouTube channel.

Delegates are encouraged to review the Township's Procedural By-law prior to their submission.

Name of Individual(s)

Name of Group/Organization (if applicable)

Phone No.

E-mail Address

Purpose of the Delegation

Recommendation to Council

Do you have any supporting documentation (presentation material, letter, memo, photo etc.) that you would like to provide to Council?

Yes

Personal information, as defined in the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25 and will be used in preparation of the Council meeting agenda.

All information submitted will be considered to be public information and therefore subject to full disclosure by way of publication of the agenda. Please note that all meetings are open to the public except where permitted to be closed to the public under legislated authority. Council meetings are recorded and uploaded to YouTube. Questions about the collection of this information may be directed to the Clerk Department: clerk@antownship.ca or 705-639-5343.

I acknowledge that the information contained in this Form, including any attachments, will become public documents and listed on the Township of Asphodel-Norwood Council Meeting Agenda Package

Yes

Signature

Clear

Date Submitted

OFFICE USE ONLY

Delegation Request	Delegation Confirmed

Date of Council Meeting	Clerk Signature