Request to Speak at Public Forum

Your details

To register to speak you must submit this form by 2pm on the day of the Public Forum. We will be in contact to confirm and give you further details.

First Name *

Last Name *

Business/Organisation Name (if applicable)

Contact phone number *

Email Address *

Your address (if applicable)

Street address

City

State

Postcode

Council meeting date *

Report number and title you wish to speak on. Please refer to the agenda *The link to the agenda will open in a new window

Are you *

FOR (in support of) the recommendation in the reportAGAINST (oppose) the recommendation in the report

Are you representing another person or persons, if so please provide details (optional)

I consent to broadcast my voice and/or image in the livestream (note: individuals who do not consent will be unable to address the Public Forum) *

I confirm that my public forum address will not include any comments or information that may present a legal risk including defamatory comments or the disclosure of personal information of another person. *

I accept personal details requested on this form will be used to process this application and may be used for any other council related business correspondence or purposes. If you cannot provide or do not wish to provide the information sought, the Council will not be able to process your application. Your name and the name of any person you are representing will be included in the livestream and audio-visual recording of the Public Forum and also in the Minutes of the Public Forum, both of which will be available on Council's website. You may make application for access or amendment to personal information held by Council. You may also request Council to suppress your personal information from a public register. *