Delegation Request Form

Current About the Delegation
Contact Information
Acknowledgement
Complete

Please complete this form if you wish to speak before Middlesex Centre Council.

This form and any additional information for consideration by Council must be submitted to the Municipal Clerk by 12:00 pm (noon) on the day prior to the requested meeting date.

Date of Meeting

Agenda Item Number (if known)

Subject

Have you been in contact with a municipal staff member or council member regarding this matter?

Yes

Name of Spokesperson

Name of Group or Person(s) being Represented (if applicable)

Brief Summary of Issue or Purpose of Delegation

Supplementary Documentation (if applicable)

Maximum 5 files.
12 MB limit.
Allowed types: pdf.