Required fields are marked with asterisks (*)

Request to Address Council

This form is for addressing Council only. For Proclamations, Certificates of Recognition and Flag Raisings, please complete the Request for Council Recognition Form. Staff will contact you to confirm details of your request once your submission has been received.

Contact Information

Please select your attendance choice:
Add any additional participants? (2)

Meeting Information

Regular Council meetings are usually held the 3rd Monday of each month. This form must be submitted by noon (12 p.m.) 10 days prior to the meeting.

Please indicate which month you would like to address to Council

Presentation Information

Will you be providing a PowerPoint, Image or video for the presentation?

Privacy & Collection Statement

Personal information including names, addresses, opinions and comments, is collected under the authority of the Municipal Act, 2001. It will form part of the record of the meeting and therefore could be made publicly available. Some Council meetings are recorded and broadcast. By requesting to address Council, you and/or your organization or group hereby consent to appear on these broadcasts. Questions about this collection may be directed to the Town Clerk at 65 Harwood Avenue S., Ajax ON, L1S 2H9 or

Accessible Formats & Accommodations Available

If you require this document in an alternative accessible format, please contact the Town of Ajax Accessibility Coordinator, at 905-6683-4550, or by e-mail at Accessibility accommodations are available during the meeting on request, please inquire with staff.