• Field Required: Your Name
  
• Field Required: Phone Number
• Field Required: Address
• Field Required: Potal Code
• Field Required: Preferred Methods
Field required: I have read and understand the disclaimer

Your Name	*
Phone Number	*
Alternate Phone Number
Address	*
Postal Code	*
Email
Disclaimer: The information you are about to submit will be stored on City of Brandon servers in order to enable the City of Brandon to respond and resolve to the issue. The City of Brandon may keep certain submitted data for statistical and analytical purposes. Personal information will not be used or disclosed for other purposes, unless permitted by FIPPA. This information is protected by the Protection of Privacy provisions of The Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and/or use of your personal information please contact fippa@brandon.ca.
I have read and understand the disclaimer *