2. Request to Appear as a Delegation at the Hospital Board
4. The Cowichan Valley Regional District Hospital Board meets at the Call of the Chair in the CVRD Boardroom at 175 Ingram Street, Duncan.
6. Please Note: Contact information supplied by you and submitted with this form will become part of the public record and will be published in a meeting agenda that is posted online when this matter is before the Hospital Board. If you do not wish this contact information disclosed, please contact the CVRD Information & Privacy Officer at 250.746.2517 or 1.800.665.3955 to advise.
8. Meeting Date*
   Meeting Date
10. Contact Information
12. Contact Name*
13. Representing
15. Number Attending
    -- Select One --12345More than 5
17. Address
19. City
20. Province
21. Postal Code
23. Telephone Number
24. Reply Email*
26. Presentation Topic and Nature of Request*
28. Do you have a PowerPoint presentation?

    1. Yes

    1. No
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29. 1. Receive an email copy of this form.
30. Email address

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31. Submit Submit and Print

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