Required fields are marked with asterisks (*)

Delegation Request

The delegation request form and any written submissions or background information for consideration by either Council or Committees of Council must be received by the Clerk's office by noon on the Monday prior to the requested meeting date.

Council Meetings are generally held on the second and fourth Thursdays of the month except in July and December (see the Council Calendar to verify meeting dates).

Should you require assistance completing this form, please contact the Clerk at 519-785-0560 ext. 222.

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of the Municipal Act, as amended. This information is collected and maintained for the purpose of requesting a delegation at West Elgin Council. Questions about this collection should be directed to the Clerk, at 22413 Hoskins Line, Rodney, ON 519-785-0560 or clerk@westelgin.net. This information will be kept private and confidential unless otherwise required by law.

Preferred Meeting Date:

Subject of Delegation

Name:

Firm/Organization:

Address:

Postal Code:

E-mail Address:

Phone Number:

Preferred method of contact

Phone

Either

Signature

I verify that the information provided on this form is true and correct to the best of my knowledge.

Do you require any accessibility accommodation?

Yes

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Delegation Request

Notice of Collection of Personal Information