Contact(s)

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Required fields are marked with asterisks (*)

Waterloo Regional Heritage Foundation

Membership Application

Name

Address

Telephone

Telephone (B)

E-mail

Occupation

Please list below the reasons why you feel you should be considered for this Foundation.

Additional information which may be helpful to the Directors in their consideration of your application, such as experience on a board, commission, committee or other organization, whether heritage related or not.

The Foundation meets at 5:30 p.m. on the fourth Tuesday of the month excluding July, August and December. If elected, would you be able to attend meetings as called?

Yes

If you have any questions please contact the Foundation Secretary at 519-575-4732 or wrhf@regionofwaterloo.ca

Applications due May 31.

Collection Notice:

Personal information requested on this form is collected under the authority of the Municipal Act and will be used to assist the Region of Waterloo in making a decision in this election. Any personal information such as name, address, telephone number, and property location included in a submission from the public will become part of the public record file for this matter. Questions regarding this collection should be forwarded to the staff member indicated above.