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Eastland Membership Registration
*
Your Details
(Required.)
First Name
Family Name
Phone Number
Email
Suburb
Postcode
*
How did you FIRST hear about 'mini & me'?
(Required.)
Eastern Regional Library
Eastland Email
Eastland Facebook
Eastland Instagram
Eastland Website
Family / Friend
Other (please specify)
*
Which day/s of the week would suit you best to attend 'mini & me' events at Eastland?
(Required.)
Monday
Tuesday
Wednesday
Thursday
Friday
Please provide details for all children aged 0-4 years
*
Your child's details
(Required.)
Name
DOB (DD/MM/YY)
*
Do you have more children aged 0-4 years?
(Required.)
Yes
No
