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2. Name of Delegate(s)*
4. Representing*
6. Contact Phone Number*
7. Contact Email Address*
11. Topic*
13. Information to Share or Concerns
15. Person(s) in Administration Familiar With the Topic
17. Decision Requested
    (Example: Information Sharing to Council, Off-Site Levy Waived, Taxes Waived, Bylaw Change, etc.)
19. Attached Information for Review
    Note that any documentation submitted (including this application) is considered "Public Information" and will appear in the Council Agenda. (Maximum Upload of 4MB. PDF documents are suggested)
20. Date of Meeting
    Delegations will be notified by the Executive Assistant, by email, informing them of which Council meeting they are scheduled to attend. Any questions on this please contact 780-849-8006.
24. Notes
    Please limit presentation to 10 minutes.
    
    If you have materials/documentation to be included in the Agenda that you cannot upload in the field above, they must be received by 4:30 p.m. on the Wednesday before you are scheduled to appear before Council.
26. The personal information requested on this form is being collected by Municipal Operation as required by the Town of Slave Lake, under the authority of the Freedom of Information and Protection of Privacy Act (FOIP act) Section 33(c). If you have any questions about the collection or use of your personal information, contact the Town of Slave Lake FOIP coordinator at 780-849-8018.
28. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Delegate's Electronic Signature*
31. Date*
    Date
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field