Required fields are marked with asterisks (*)

Delegation Request Form

Please note, there is a 10 minute time limit for all delegation presentations.

Main Contact Name:

Group/Organization (if any):

Street Address:

City / Town:

Postal Code:

Phone:

Email:

Subject of Presentation:

Describe the full nature of your presentation:

Provide the name, title and group/organization of all presentation participants:

Will you have digital visual aids to support your presentation?

Yes

The personal information collected on this form is protected under the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and the Personal Information and Electronic Documents Act (PIPEDA). The information will only be used by County Staff in the preparation of agendas and will not be disclosed or used for any other purpose.

Please direct inquiries to the Clerk, County of Lambton at clerk@county-lambton.on.ca.

You will be notified of the time and date of your presentation, if approved.

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Delegation Request Form