Joint Accessibility Advisory Committee Application Form

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

Name *

Property Address (Including postal code) *

E-mail

Phone Number *

Are you at least 18 years old? (check this box to confirm) *

I hereby authorize the release of the personal information contained in my application to Council, the County of Wellington and appropriate staff (Check this box to confirm) *

I hereby authorize that my name may be made public for committee purposes (Check this box to confirm)

Why would you like to participate on this Committee? *

Please describe your skills, knowledge and experience (lived experience, work related, community service oriented, or other volunteer activities) you could contribute as a member of this Committee *

If you have a disability or connection to someone with a disability please explain the type of disability and how your experience will benefit the Committee *

The Committee typically meets 3-4 times per year during business hours (1:30 PM), please confirm your availability to attend meetings by checking this box *

Optional: you are invited to upload a copy of your resume to provide any additional information about your experience