Required fields are marked with asterisks (*)

Township of Scugog Delegation Request Form

If you wish to speak at an upcoming meeting, please ensure this form is fully completed.

The public can apply to speak at a General Purpose & Administration Committee meeting or a Planning & Community Affairs Committee meeting. Please refer to the council schedule before requesting your date.

Requests must be received no later than 4:00 p.m. on the Tuesday preceding the meeting.

For additional information or clarificaiton please contact the Clerk's Department at clerks@scugog.ca.

Date of Meeting

Name of Delegation / Person(s) Speaking

Each indivdual delegate will be given a five (5) minute time slot to address the Council. Please note delegation time cannot be combined to exceed the five (5) minute limit for each indivdual speaker.

Contact Name

Phone Number (999-999-9999)

Email Address

Address

Town/City

Province

Postal Code

Group Delegation Represents

General Nature of Delegation

How will you be attending?

Attending in-person

Attending virtually

Please indicate the Action being requested by Council (if applicable):

Note: Committee and Council meetings are live streamed and recorded. By requesting to address Council, you and/or your organization or group hereby consent to appear on these broadcasts.

Personal Information on this form is being collected under the authority of the Municipal Freedom of Information and Protection of Privacy ACt, R.S.O. c.F.31, s. 39 (2).

Questions about this collection may be directed to the Clerk's Department, Township of Scugog, 181 Perry Street, PO Box 780, Port Perry, ON, L9L 1A7, clerks@scugog.ca or 905-985-7346.