Online Community Forum Question Form

This form needs to be completed in order to make a presentation on an Agenda Item or Topic at a Community Forum. The form must be submitted to Council by 12pm on the day of the Community Forum.

The personal information you supply in this form and any documents attached are collected by Wollondilly Shire Council for the purpose of community consultation and matters of concern at Community Forums. The information collected on this form may or may not be recorded in the Community Forum Record of Proceedings. Regardless of whether the information is recorded in the Community Forum Record of Proceedings, the information shall be stored on Council's Electronic Data Management System. As such, this information could be subject to a request for access to information under the Government Information (Public Access) Act, 2009.

By submitting this form you are indicating that you have read and understood Council's Privacy Statement and that the personal information provided is correct.

If you need further information or assistance, please contact Council's Administration Officer on 4677 1100.

Date of Forum*

Full Name*

Address

Phone Number*

Email*

Please indicate below the section of the Community Forum your question relates to:

Formal Community Forum Matters

Community Question/Statement Time

Information Question/Statement Time

Please provide details of who you will be representing e.g. yourself, organisation or other party

Please select if you wish to speak on an Agenda Item or Topic?

Agenda Item

Topic

Please provide details about the Agenda Item or Topic you wish to speak about

Please write your question/statement using no more than 1,000 words

Upload additional information

If it becomes necessary to consult with third parties, do you consent to the disclosure of personal information if requested?*

Yes

Have you made a political donation? (If 'yes', you must fill in and submit the Disclosure of Political Donations Form and forward to Council.)*

Yes

2019 Meeting Schedule
Monday 9 September, 6.30pm
Wednesday 16 October, 6.30pm
Monday 11 November, 6.30pm
Monday 2 December, 6.30pm

Wollondilly Shire Council

2019 Meeting Schedule