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Accessible Format Request Form

First Name

Last Name

House #

Street Name

Unit # (if applicable)

City

Province

Postal Code

Home Phone Number

Alternate Contact Number

e-mail address

Document Title

Name of Event

Date of Event

Accessible format or communication support requested;

Please indicate any specific technical needs;

What date do you require the information by?

Personal information on this form is collected under the authority of section 367(1) of the Municipal Act, R.S.O. 1990, c. M.45. It will be used to provide a document or information produced by the City of Woodstock, as requested. Questions about this collection may be directed by mail to the City Clerk, City of Woodstock, 500 Dundas Street, Box 1539, Woodstock, ON,N4S 0A7.