Emu Point to Middleton Beach Coastal Hazard Risk Management Adaptation Plan (CHRMAP)

Community Advisory Panel Nomination Form

We are inviting the community to take on an extremely important role - to help guide the Emu Point to Middleton Beach CHRMAP through participation in a Community Advisory Panel.
If you would like to nominate to be part of a panel of participants please provide your details below.

Question Title

* 1. How do you identify?

Male

Not Stated

Female

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* 2. Who do you represent? (choose the most relevant)

Business owner/operator in the City of Albany

Resident (tenant) in the City of Albany

Resident (owner occupier) in the City of Albany

A specific stakeholder group in the City of Albany (please specify)

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* 3. What is your age group?

Under 17

18-27

28-37

38-47

48-57

58-67

68+

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* 4. What is your residential or business location? (choose the most relevant)

Emu Point -Middleton Beach area

Collingwood Park, Spencer Park, Mira Mar

City of Albany area – other

Visitor

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* 5. Please confirm that you are available on Tuesday 4th December 2018 from 8am – 12pm, and on Saturday 8th December 2018 from 1pm – 5pm

Yes

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* 6. Please provide some details so we can get in touch.

Name *

Company

Address

Address 2

City/Town

State/Province

Email Address *

Phone Number *