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Application Form for Committee/Board Appointments

Name

Mailing Address

Mailing Address Line 2

Town/City

Province

Postal Code

Phone Number

Alternate Phone Number

Email Address

Are you 18 years of age or older?

Yes

Please select the committee that you wish to be considered for:

Brock Economic Development Advisory Committee (BEDAC)

Brock Tourism Advisory Committee (BTAC)

Brock Environmental Advisory Committee (BEAC)

Beaverton Harbour Advisory Committee (BHAC)

Please select the committee that you wish to be considered for:

Why are you interested in serving on this committee?

Have you previously served on any Township of Brock appointed board(s)/committee(s)?

Yes

Please provide any additional details you wish to share

Please attach your resume (if available)

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Confirmation

I hereby confirm that the information provided in this form is true, complete, and accurate to the best of my knowledge.