Date of Meeting (Delegations are Allotted 10 Minutes to Speak)
Subject Matter:
Have you been in contact with a staff member in regard to this matter? YesNo
If yes, with whom?
What was the outcome of your discussion?
Recommendation to Council/Committee: Please indicate below what action you would like Council or Committee to take with respect to your delegation. Use a separate page if more space is required or attach additional documentation.
Contact Information: Please note that this information will be used to contact individuals and/or organizations who have requested to appear as a delegation before Town of Bancroft Council or Committee. The name of the delegate and/or organization will appear on the meeting agenda, which is also posted on the Town’s website.
Do you require any accessibility accommodation? If yes, what do you require?
Additional Documentation and Presentation Materials
Will you require A/V equipment? If yes, please describe:
Any material or documentation MUST be provided to the Clerk by 12:00 noon on the Tuesday preceding the meeting date.
Electronic format is preferred for all delegation materials.
If the delegation wishes to have paper materials distributed, twelve (12) copies must be provided to the Clerk by the deadline noted above. If any additional documentation is brought forward on the date of the meeting, it is to be provided directly to the Clerk, and the Chair will determine if it is to be distributed at the meeting.
Please Direct Any Questions and Return the Completed Delegation Request Form to:
Clerk Department
Town of Bancroft
8 Hastings Heritage Way
PO Box 790
Bancroft, ON, K0L 1C0
[email protected]
(p) 613 332 3331 x 208
(f) 613 332 0384
Personal information contained on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, and will be used for the purpose of providing correspondence relating to matters before Council/Committee. Please note that all meetings are open to the public except where permitted to be closed under legislated authority.
Delegation Request Acknowledgement
I, ,do hereby acknowledge that I have read and reviewed Section 12 of the Town of Bancroft By-Law to Govern and Regulate the Proceedings of the Corporation of the Town of Bancroft (as attached), which relates directly to Presentations/ Delegations/ Deputions.
On behalf of (group name, if applicable):
Signature:
Security Measure