CCMDC Project Aware - 4Villages - Registration

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* 1. Contact Information

Name

Suburb

Email Address

Phone Number

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* 2. Year of your birth

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* 3. How long have you lived in this area?

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* 4. List any local groups, organisations and/or networks that you are involved with:

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* 5. Why are you interested in this project?

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* 6. What would you most like to learn about in relation to the local area?

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* 7. Can you commit to attending the weekly program including two weekend field trips?

Yes

No

Comment:

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* 8. How did you hear about the program?

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* 9. Any other comments or questions?