Community Engagement Stakeholder Register

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* 1. Salutation (e.g Mr, Mrs, Miss, Ms etc)

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* 2. First Name

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* 3. Last Name

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* 4. Age

Under 15

16-25

26-35

36-45

46-55

56-65

66-75

76-85

86 & over

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* 5. Gender

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* 6. Phone number

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* 7. Email address

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* 8. Town or Locality

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* 9. Postcode

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* 10. What Fraser Coast Regional Council Division do you live in? ( if you are unsure please follow this link: https://results.ecq.qld.gov.au/local_area_maps/

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* 11. Do you speak a language other than English at home?

Yes

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* 12. Do you identify as Aboriginal or Torres Strait Islander

Yes - Aboriginal

Yes - Torres Strait Islander

Yes - Both

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* 13. Do you identify as a member of a cultural or ethnic group?

Yes

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* 14. Do you identify as a person with a disability?

Yes

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* 15. What interests do you have in relation to Council and Community Engagement opportunities?

Economic Development

Youth Development

Arts & Cultural

Environment

Inclusive communities

Sport and Recreation

Community Development

Parks, Gardens and Open Spaces

Planning and Development

Recycling, Sustainability and Water

Other (please specify)

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* 16. What types of community engagement activities would you like to be involved in?

Community Panels or Community Reference/ Advisory Groups (you will be added to our community panel pool until the end of 2020 - this pool will be reviewed every 12 months)

Be informed - receive information and updates about community engagement projects via email

Stakeholder activities - get involved at workshops or meetings to assist in future planning or decision making

Online consultation - provide your feedback online via submissions or surveys - via the website or information sent to you by email

Engagement Hub - Register for our Engagement website, to keep up to date with Council projects and take part in various engagement activities. (If you tick yes you will receive an email from engagement hub to register). https://frasercoast.engagementhub.com.au

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* 17. What is your current level of community involvement in your Community?

Part of the community

Member of a community organisation

Committee/executive member of a community organisation

Business owner

Community advocate

Volunteer

Member of a community club

Other (please specify)

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* 18. Terms and Conditions
By completing and submitting Fraser Coast Regional Council's Community Engagement Stakeholder Registration Form, it means that you have consented to having your personal details added to our Community Engagement Stakeholder Register. Your Personal details will remain confidential and will only be used for the purposes of community engagement activities coordinated by Fraser Coast Regional Council and consultants employed by Council to run and coordinate community engagement projects.

You can accept or decline any offer to participate and at any given time your details can be removed from the Fraser Coast Regional Council Community Engagement Stakeholder Register on your request.

Agree

Disagree

Thank you for taking the time to complete your registration form to be involved in community engagement activities run by Council. If you have any questions or would like to discuss this form please do not hesitate to contact the Community Development and Engagement Team on: community@frasercoast.qld.gov.au or 1300 79 49 29