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Rural Water Pricing and Services: Paired Conversations Sign-up

10.Some basic information from you

The feedback received from our discussion kits will allow us to facilitate groups of people online to discuss perspectives on topics where their views might differ. 

If you'd like to participate in these paired conversations, please opt-in below.

If you participated in a kitchen table discussion but weren't the one who submitted your answers, you will need to provide the name of the person who did, so we can correctly match your feedback with you.

If you have any questions, please contact The newDemocracy Foundation at: water@newdemocracy.com.au
1.What is your name?(Required.)
2.What town or suburb do you live in?(Required.)
3.What is your postcode?(Required.)
4.What is your telephone number?(Required.)
5.What is your email address?(Required.)
6.If you did not submit your groups' discussion kit, please provide the organisers' name here, so we can correctly match your responses:
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