Designated Members In Charge

All Designated Members In Charge must be bona fide members of the organization and are required to complete this form.

Organization name

We, as active, bona fide members of the above named organization hereby certify that as the designated members in charge of lottery events for the organization we will be responsible for the management and conduct of the lottery events in accordance with the terms and condition of any and all lottery licence(s) as issued.

We, as bona fide members, have signing authority and hold a senior position with the organization. The following list includes our positions within the organization and telephone numbers.

The first three members are listed in the order they are to be contacted regarding lottery events. An additional three to five members and their contact information is also provided below in case the first three are not available.

Name

Title

Other Position(s) held in the Organization

Mailing Address

Town

Postal Code

Phone

Email Address

Name

Title

Other Position(s) held in the Organization

Mailing Address

Town

Postal Code

Phone

Email Address

Name

Title

Other Position(s) held in the Organization

Mailing Address

Town

Postal Code

Phone

Email Address

Three to five additional members and their contact information.

Notice of Collection: Personal information contained on this form is collected pursuant to the Municipal Act, and will be used for lottery purposes only. Enquiries regarding the collection of this information may be directed to the Office of the Clerk/Freedom of Information Coordinator, Municipality of Trent Hills, 66 Front Street South, Campbellford, ON K0L 1L0 705-653-1900.

Land Acknowledgement

We recognize the traditional keepers of this land and, specifically our neighbours of the Alderville First Nation, with a formal territorial acknowledgement.

Welcome to the Gunshot Treaty Lands of 1788. It is on these lands and on the shores of the big lake, the Mississauga Anishinabeg met with the Crown to facilitate the opening of these lands for
settlement.

Let us be reminded of the responsibility we all have in making sure that we respect these lands and waters that give us life and sustain our livelihoods.