Citizen Participation Form

CITIZEN PARTICIPATION FORM

This Citizen Participation Agreement is entered into by and between Participant Name: and Organization Name: . Effective Date:

WHEREAS

WHEREAS, the Organization administers community outreach, public engagement activities, and local projects and seeks input, participation, and services from residents and community stakeholders for the purpose of advancing public programs and policies; and

WHEREAS, the Participant has skills, knowledge, or community standing relevant to the Project Name: and is willing to participate on the terms set forth herein; and

WHEREAS, the parties desire to set forth their respective responsibilities, compensation (if any), confidentiality obligations, and the governing terms that will apply to the Participant's engagement.

Participant Information

I represent an organization or constituency and have authority to speak on its behalf

Scope of Work

The Participant shall perform the following services, activities, and duties as part of the Project. The description below shall control the work to be performed unless otherwise amended in writing and signed by both parties.

Payment Terms

If applicable, the Organization will compensate the Participant as follows. Any payment is subject to the Organization's fiscal policies, verification of completion of the Scope of Work, and submission of required documentation.

Term and Termination

This Agreement commences on Start Date: and terminates on End Date: unless earlier terminated in accordance with this section.

Either party may terminate for convenience upon providing written notice of termination to the other party at least days prior to the effective date of termination. The Organization may terminate immediately for cause upon written notice if the Participant breaches any material obligation and fails to cure within a reasonable period.

Confidentiality

"Confidential Information" means non-public information disclosed by the Organization or by the Participant in connection with the Project that is identified as confidential or that a reasonable person would understand to be confidential under the circumstances. The receiving party shall: (a) hold Confidential Information in strict confidence; (b) not disclose it to third parties except as authorized in writing; and (c) use Confidential Information only for the purposes of performing under this Agreement. Confidentiality obligations shall not apply to information that is (i) in the public domain through no fault of the receiving party, (ii) rightfully received from a third party without restriction, or (iii) required to be disclosed by law or valid order of a court or government agency, provided the disclosing party is given prompt notice and an opportunity to seek protective measures.

Acknowledgement of Confidentiality: I have read, understand, and agree to the confidentiality provisions set forth above.

Consent and Releases

The Participant consents to reasonable audio and/or video recording of participation, and to the Organization's use of such recordings, photographs, summaries, or quotes for reporting, outreach, and documentation purposes, unless the Participant explicitly withholds such consent below.

I consent to audio/video recording and use of my likeness, statements, and contributions as described above.
I withhold consent for audio/video recording and use of my likeness (select only if withholding).

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict-of-law principles. Exclusive venue for any action to enforce this Agreement shall be the state or federal courts located in that state, unless the parties mutually agree otherwise in writing.

Indemnification

The Participant agrees to indemnify, defend, and hold harmless the Organization and its officers, employees, and agents from and against any third-party claims, liabilities, losses, damages, costs, or expenses (including reasonable attorneys' fees) arising out of or resulting from the Participant's breach of this Agreement, negligent acts, willful misconduct, or violation of applicable law in connection with participation.

Entire Agreement

This document, including any attachments or written amendments signed by both parties, constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior or contemporaneous oral or written agreements, representations, and understandings. Any modification or waiver must be in writing and signed by both parties.

Certification

By signing below, the undersigned certify that they are authorized to enter into this Agreement, that the information provided on this form is true and accurate to the best of their knowledge, and that they accept and agree to be bound by the terms set forth herein.

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