Regional Chair's Community Roundtable

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Engage Region of Waterloo
Regional Chair's Community Roundtable
2020 Application

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2020 Application

Thank you for your interest in participating in the Regional Chair’s Community Roundtable. Feel free to review the Terms of Reference – it will likely answer any questions you might have about the meetings.

The application form will take approximately five minutes to complete.

Tell us about yourself

Your responses will help ensure a diverse group of residents attend the meetings. Contact information collected will only be used to communicate with you about the Community Roundtable meetings.

Name: *Required

Maximum characters 255

What is your email address? *Required

Maximum characters 255

What is your daytime phone number? *Required

Maximum characters 255

Where do you live in Waterloo Region? * required

City of CambridgeCity of KitchenerCity of WaterlooTownship of North DumfriesTownship of WellesleyTownship of WilmotTownship of WoolwichPrefer not to answerI don't know

What is your gender? * required

MaleFemaleOr please specifyPrefer not to answer

Specify:

Maximum characters 255

What is your age? * required

18-2425-3435-4445-5455-6465-7475-8485 years and olderI don't knowPrefer not to answer

When are you available? Please indicate below which of the meeting dates you're available to attend. You can select more than one date, but you will only be asked to attend one meeting. This will give other residents the opportunity to participate. Meetings will be held in the evenings from 6:30 - 8:30 p.m. at the Regional Administration Building, 150 Frederick Street, Kitchener, ON * required

Thursday, March 19, 2020Thursday, June 25, 2020Thursday, December 10, 2020

Options are limited to

Thank you

Thank you for taking the time to express your interest in participating on the Regional Chair’s Community Roundtable. You will receive a follow-up email from staff in the Regional Chair’s Office.

Cancel

Please hold on while your response is being submitted