Application to Wellington County Safe Communities Committee Name Email Phone number Are you an Erin resident Yes No Address Please indicate any Committee(s)/Board(s) you have previously served; and any other community volunteer work or involvement: * Explain your intention and commitment to serve on on this Committee and how you would contribute to Erin in a meaningful way? * Please explain how your appointment would benefit the residents of Erin? * Please choose the type of current or previous employment Business Owner/Manager Education Finance Government Health Social Services Retired Other Consent for storing submitted data * Yes, I give permission to store and process my data No, I don't consent to storing and processing my data Personal information, as defined in the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001 and will be used in accordance with MFIPPA. Questions about this collection of personal information should be directed to the Clerk's Office, 5684 Trafalgar Road, Hillsburgh, ON N0B 1Z0, Telephone, 519.855.4407 x248 or lisa.campion@erin.ca