Welcome

Please complete this form if you would like to speak at a Regional Council or Committee meeting.

Note: The meetings are public so you do not need to register to attend.

What is your first name?

What is your last name?

What are you speaking as?

An individual

A member of an organization

A Regional Employee

What is your address?

What is the unit number (if applicable)?

Which city or township do you live in?

Waterloo

Cambridge

Kitchener

North Dumfries

Wellesley

Wilmot

Woolwich

Other (please specify)

What is your postal code?

What is your home or business phone number?

Please provide your cell phone number (if applicable)

Do you have an email address?

Yes

No

Region of Waterloo Form