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Application for the Appointment to a Board or Committee

Personal information collected on this form is collected under the authority of the Municipal Act, 2001, as amended, for the purposes of reviewing this application. Questions regarding the collection of personal information should be directed to the Municipality of North Perth, 330 Wallace Avenue North, Listowel ON N4W 1L3, telephone 519-292-2062, Clerks Department.

Applicant's Name

Phone Number

Street Address

Email Address

Town/Province/Postal Code

Are you a North Perth Resident?

Yes

Are you a North Perth Property Owner?

Yes

Are you a North Perth Business Owner

Yes

Are you 18 Years of Age or Older?

Yes

1st Choice of the Board or Committee you are Applying For?

2nd Choice of Board or Committee you are Applying For?

Describe your Previous Experience Serving on Committees and Boards in the Community.

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