Contact Information:

First name 1:
Last name 1:
Email 1:
First name 2:
Last name 2:
Email 2:
Street number:
Street name:
Suburb:
Postcode:
Phone (AH):
Phone 1 (BH):
Phone 2 (BH):
Phone 1 (Mobile):
Phone 2 (Mobile):
Preferred method of contact:	--------- Mobile Phone AH Phone BH Email
Registration type:	--------- Resident Organisation
Do you want to receive email newsletters about environmental events, opportunities or activities:	--------- Yes No

Privacy Information:
Your personal information is being collected by Council primarily for the purpose of establishing and maintaining an internal database in relation to our Community Environment programs. Your personal details will be used solely by Council for the primary purpose stated above or for a directly related purpose such as sending newsletters and other relevant information. The applicant understands that the personal information provided is for these purposes and that they may apply to Council for access and/or amendment of the information. Your personal information will not be shared with other parties outside Council.