TOWN OF VIEW ROYAL PETITION & DELEGATION REQUEST FORM - Doug Harbicht

TOWN OF VIEW ROYAL PETITION & DELEGATION REQUEST FORM

*Before completing this form, please refer to the Petition & Delegation Information Package

Request to appear on: Year: 2019 Month: November Day: 12

[ ] Council [x] Committee of the Whole

Anyone wishing to be placed on an agenda to address Council or Committee of the Whole may apply by delivering a request in writing to the Corporate Officer by 12:00 noon on the Thursday preceding the meeting date by completing this application form. Council meetings are held on the 1st and 3rd Tuesdays of the month with the exception of August; and only the 1st Tuesday of the month in December.

Each delegation is limited to fifteen (15) minutes unless extended or reduced by unanimous resolution of Council members present.

Date: October 09/2019 Email: Name of Applicant: Doug Harbicht On Behalf of: Stormont Road Residents (Organization, Business, Self, etc.) Mailing Address: 240 Stormont Road Victoria BC. V9B1P6 Local Street Address: 240 Stormont Road Tel #: Fax:

Details of Presentation: Request to Mayor and Council for effective speed bumps on Stormont Road

List any requested audio visual needs – please note all presentations must be submitted at the time of application: Power point and video

NOTE: Council and Committee of the Whole meetings are public meetings. The information on this form will become part of the public record and will be made available to Council, staff, media and the public. The information on this form is collected in order to respond to your request to appear before Council. If you have any questions about the collection and use of this information, please contact the Corporate Officer. The agenda is posted on the public notice board at the Town Hall and complete agenda packages are available on the Town’s website (www.viewroyal.ca) and are available for viewing at Town Hall.

Please return completed form to the attention of the Deputy Corporate Officer by fax to 250-727-9551, by email to info@viewroyal.ca or in person to View Royal Town Hall, 45 View Royal Avenue, Victoria, BC V9B 1A2