PETITION & DELEGATION REQUEST FORM - ALEX BATKO

TOWN OF VIEW ROYAL

PETITION & DELEGATION REQUEST FORM

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

Request to appear on: 2016 - JANUARY - 19

[x] Council [ ] 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: Jan. 13, 2016 Name of Applicant: ALEX BATKO On Behalf of: self (Organization, Business, Self, etc.) Mailing Address: 311-286 Wilfert Rd., Victoria, BC Local Street Address: (same) Tel #: [Redacted] Fax: /

Details of Presentation: novel proposal for medical marijuana dispensary

List any requested audio visual needs: it would be convenient to be able to show you a slide show during my presentation. Thank you.

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 distributed 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 on the Town's website www.viewroyal.ca. Complete agenda packages area available for viewing at Town Hall.

Please return completed form to the attention of the Deputy Municipal Clerk 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