Committee Application Form

Would you like to get involved in your community and make an impact on its future? Please fill out the form below to apply to a committee.

For more information, please contact:
Kate Barchard, Corporate Officer
604.465.2462
kbarchard@pittmeadows.ca

Your Name *

Your Address

Home Phone Number

Work Phone Number

Cellular Phone Number

Your Email Address *

Seeking Nomination To *

Active Transportation Advisory Committee

Advisory Design Panel

Agricultural Advisory Committee

Board of Variance

Municipal Advisory Committee on Accessibility Issues (serving Maple Ridge and Pitt Meadows)

Briefly state your reasons and interest in applying for membership to the Committee *

What is your background/experience/expertise that is relevant to this nomination? (Please include relevant resume information) *

What do you hope to contribute by your participation? *

NOTICE: Personal information requested on this form is collected under the authority of Section 26 of the Freedom of Information and Privacy Act, R.S.B.C. 1996, c. 165, as amended. Unless otherwise specified, the information gathered will be used by the City of Pitt Meadows for committee application processing purposes only. Questions about the collection, use, and disclosure of this information should be directed to the Head for Freedom of Information and Protection of Privacy, City of Pitt Meadows, 12007 Harris Road, Pitt Meadows, BC, V3Y 2B5, 604.465.2462.

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