Online Form - COPY - EXPRESSIONS OF INTEREST- Gala Night Working Group

Name *

Address *

Contact Phone Number *

Contact Email Address *

Do you have any specific skills or experience that you could bring to this working group?

Please provide more details (eg. business name)

I am *

a business owner
a business representative
a stall holder
an entertainment provider
other

Have you previously been in the Gala Night working group? *

YesNo

Please indicate your availability for meetings *

Please indicate a time that you may be available for meetings (if applicable)

Are you involved in any other community groups or services? if so, please list them and your role:

Why would you like to be involved in the working group?

Welcome to the Shire of MERREDIN