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2020 Application

Thank you for your interest in participating in the Regional Chair’s Community Roundtable. Feel free to review the Terms of Reference – it will likely answer any questions you might have about the meetings.

The application form will take approximately five minutes to complete. 


Tell us about yourself
Your responses will help ensure a diverse group of residents attend the meetings. Contact information collected will only be used to communicate with you about the Community Roundtable meetings.

Maximum 255 characters

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Maximum 255 characters

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Maximum 255 characters

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4.   Where do you live in Waterloo Region?* required
5.   What is your gender?* required
6.   What is your age?* required
7.   When are you available? Please indicate below which of the meeting dates you're available to attend. You can select more than one date, but you will only be asked to attend one meeting. This will give other residents the opportunity to participate. Meetings will be held in the evenings from 6:30 - 8:30 p.m. at the Regional Administration Building, 150 Frederick Street, Kitchener, ON* required
Thank you
Thank you for taking the time to express your interest in participating on the Regional Chair’s Community Roundtable. You will receive a follow-up email from staff in the Regional Chair’s Office.