Required fields are marked with asterisks (*)

Public declarations of interest registry

First name

Last name

Meeting date

Subject matter/report title

General nature of conflict

I understand that checking this box constitutes a legal signature, and also understand that by checking this box, I confirm that the information contained on this form (both default wording in the form and that I entered by myself) are true and accurate.

Yes, I understand.

Land acknowledgement

The City of Kitchener is situated on the traditional territory of the Chonnonton, Anishinaabeg, and Haudenosaunee Peoples. We recognize our responsibility to act as stewards for the land and honour the original caretakers who came before us. Our community is enriched by the enduring knowledge and deep-rooted traditions of the diverse First Nations, Métis, and Inuit Peoples who live in Kitchener today.