Stay Safe, Stay Connected Weekly Challenge Submission

First Name *

Last Name *

Phone Number *

Email Address *

Suburb *

Do you agree to the full Terms and Conditions? *

Privacy Statement
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.
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. *

Attach any relevant photos or documents here *

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By submitting this entry, you will go in the draw to win a $50 gift voucher for your nominated category. Submissions must be completed separately for each category. You will also gain a bonus entry into the monthly Stay Safe Stay Connected Champion draw.