Disability Agencies and Organisations - webpage listing application form

Contact information of person submitting this request

First Name *

Surname *

Email address of person submitting request *

Information requesting to be added to webpage

Organisation Name *

Organisation website link *

Organisation generic email address (optional)

Organisation generic phone number (optional)

Note - the following is a short description of your organisation, those wishing to know more will be able to link to your website to find out further details. Please keep this brief.

Short blurb (1-2 sentences) about what your organisation offers *

Terms and Agreement

I agree that it is at the discretion of CBCity to add or remove these details from their website *

Yes

Privacy Notice

In submitting this form, you consent to Council:

1. collecting your personal information as contained in the form; and

2. 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.