Community Talk Request

(Talks last 30-45 mins in duration)

Organisation *

Address *

Suburb *

Contact Name *

Contact Number *

Email Address *

Visit Type *

Location *

Topics available (please indicate preference) *

Other location (please specify) *

Date Preferences

Select date and time (please chooe dates 4-8 weeks in advance)

1st Date Preference *

Start Time

End Time

2nd Date and Start Time Preference *

Start Time

End Time

3rd Date and Start Time Preference *

Start Time

End Time

Approx. number of people attending *

Visit Details *

PRIVACY STATEMENT

In submitting this form, you consent to Council:

Collecting your personal information as contained in the form; and
Using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process your application/request.

You may access any of your personal information that Council holds upon request.

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