Expression of Interest Form

Please indicate your interest in participating in the Upper York Sewage Solutions Individual Environmental Assessment Community Liaison Forum by completing this form and e-mailing or faxing it to the contact below by April 15, 2010:

Adrian Coombs, P.Eng.
York Region Senior Project Manager

adriancoombs@york.ca

1.	Your Name:*

2.	Why are you interested in participating on the Community Liaison Forum?*

3.	What would you bring to the Forum in terms of knowledge of the study area (see map attached to the Community Liaison Forum Roles and Responsibilities), interest in the study, other qualifications, etc.?*

4.	Why do you feel that you would make a good addition to the Forum?*

5.	If representing an organization, which organization do you represent and what is your role in that organization, i.e., member, Chair, etc.?*

6.	How can we contact you (Please include a daytime phone number, mailing address, and e-mail address, and indicate the best way to reach you)?*