Accessibility Advisory Committee Application Form

Name

Name of organization (if applicable)

Civic Address

Address Line 1

Address Line 2

City

Province

Postal Code

Mailing Address

Address Line 1

Address Line 2

City

Province

Postal Code

Phone number

Email address

Please explain what makes you an ideal candidate for the Accessibility Advisory Committee

You may attach a resume and/or another sheet of paper to this application if necessary.

Supporting document

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organization of applicable)

Please check all that apply:

I have lived in the Municipality of Inverness County for six months or more as of the date of application.
I am over 18 years of age.
I do not have any real or perceived conflict of interest with the committee, including direct or indirect pecuniary interest with the municipality, staff, and/or individual councillors.

Disclosure of such potential conflicts does not mean that an applicant is automatically ineligible for an appointment, but the nominating committee and council must assess potential conflicts in its determination of whether an applicant may be considered further. If there is a potential conflict, please attach a separate sheet explaining this conflict.

Conflict of interest explanation

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Date Submitted