FuturesPlan20 Community Panel registration

1. City of Canada Bay FuturesPlan 20 Panel registration

Complete this registration form to join the City of Canada Bay FuturesPlan 20 Panel.

Question Title

* 1. Please tell us about yourself, or the organisation you represent:

Name: *

Company:

Address: *

Address 2:

City/Town: *

State:

ZIP/Postal Code:

Email Address: *

Phone Number:

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* 2. Please tell us your preferred method of receiving information from Council in your capacity as a panel member:

Hard copy (mail)

Soft copy (e-mail)

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* 3. Please tell us your age

Under 18

18-29

30-39

40-49

50-59

60-69

Over 70

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* 4. Please tell us your gender

Male

Female

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* 5. Primary language spoken at home:

Arabic

Cantonese/Mandarin

English

Greek

Italian

Korean

Other (please specify)

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* 6. What is your interest in the City of Canada Bay: (resident, non-resident property owner, business operator, other)

I live here (rent)

I live here (own)

I own property in the City, but live elsewhere

I own or operate a business in the City

Other

Other (please specify)

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* 7. Household income per annum

Less than $39,999

$40,000-$59,999

$60,000-$79,999

$80,000-$99,999

$100,000-$119,999

More than $120,000

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* 8. Please indicate your areas of interest (select as many as you wish)

Community infrastructure

Council communications

Council management

Council services

Council's strategic planning

Cultural development

Development issues

Economic development

Global environmental issues

Library services

Local community facilities

Local environmental issues

Local transport

Open space management

Strategic land use planning

Traffic management

Other (please specify)