Delegation Request Form

Current About the Delegation
Contact Information
Acknowledgement
Complete

Please complete this form if you wish to speak before Middlesex Centre Council with respect to an item on an agenda.

This form and any additional information for consideration by Council must be submitted to the Municipal Clerk by 4:30 p.m. on the Monday of the week of the scheduled meeting.

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.