ࡱ> W bjbj 4jeje.8Gl|+/pr$r$r$+++++++$.-/)+%#r$%%)+ >+***%^+*%+**J*P5K&**T+0+*j0&j0*j0*r$Z$@* %4@%r$r$r$)+)+})r$r$r$+%%%%j0r$r$r$r$r$r$r$r$r$ : Form A Petition submitted by individuals Please refer to the Guidance on submission of Petitions before completing this form. If you need any further information or advice, please contact the Petitions Officer whose details are provided at the end of this form. Details of the Principal Petitioner Please enter the name of the person and organisation (if applicable) raising the petition. Please include a contact address to which correspondence may be sent, a contact telephone number and e-mail address if available.  SHAPE \* MERGEFORMAT  Title of petition  SHAPE \* MERGEFORMAT  Petition statement Please state (in no more than 250 words) what action you wish the Council to take.  SHAPE \* MERGEFORMAT  Action taken (if any) to resolve issues of concern before submitting the petition Before a petition is submitted, petitioners are expected to have taken reasonable steps to try to resolve the issues. Please enter below details of any individuals or organisations approached. Copies of correspondence, including any responses, should be attached. This information will be made available to the Petitions Committee before it considers the Petition.  SHAPE \* MERGEFORMAT  Appearance before Petitions Committee The Convener of the Petitions and Committee may invite petitioners to appear before the committee to speak in support of their petition if it is considered this would be useful in helping the Committee reach a decision. Please indicate below whether you wish to submit a request to make a brief statement to the committee when it is considering your petition.  I DO wish the opportunity to make a brief statement before the Committee   I DO NOT wish to make a brief statement before the Committee  Signature of the Principal Petitioner When satisfied that the petition meets all the criteria outlined in the Guidance on submission of petitions, the Principal Petitioner should sign and date the form in the box below. Any additional sheets of signatures should be attached to the form. The personal information you have provided on this form will only be used in connection with the administration of the petition. Your informationmaybe shared between the petition organiser, the City of ý Council'sofficers and its elected members, and will not be shared with third parties unlessyou consent to the information being shared or there is a legal requirement to do so. Your information will be held, storedand destroyed securely in line with the Council's record retention policyand in accordance with the principles of the Data Protection Act 1998. Signature Date .. Name in block capitals . Submission A petition must be supported by at least 200 signatures from people living in the City of ý Council Area and on the Register of Electors. The Convener has discretion to declare a petition with greater than 50 signatures to be valid. Please submit this form and attachments by e-mail, by post or in person to: Petitions Officer, The City of ý Council, Business Centre 2.1, Waverley Court, 4 East Market Street, ý, EH8 8BG. Tel: 0131 529 4210 E-mail: petitions@edinburgh.gov.uk Signature of those individuals supporting the petition Title of petition  SHAPE \* MERGEFORMAT  DATA PROTECTION: FAIR PROCESSING NOTICE The personal information you have provided on this form will only be used in connection with the administration of the petition. Your informationmaybe shared between the petition organiser, the City of ý Council'sofficers and its elected members, and will not be shared with third parties unlessyou consent to the information being shared or there is a legal requirement to do so. Your information will be held, storedand destroyed securely in line with the Council's record retention policyand in accordance with the principles of the Data Protection Act 1998. NAME ADDRESS SIGNATURE 20 Signature of those individuals supporting the petition Title of petition  SHAPE \* MERGEFORMAT  DATA PROTECTION: FAIR PROCESSING NOTICE The personal information you have provided on this form will only be used in connection with the administration of the petition. Your informationmaybe shared between the petition organiser, the City of ý Council'sofficers and its elected members, and will not be shared with third parties unlessyou consent to the information being shared or there is a legal requirement to do so. 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