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Registration Form for Help us shape the Darebin you want to live in

The information collected will only be used for the purpose of this survey and Council will treat your privacy confidentially. The collection and handling of personal information is in accordance with Council's Privacy Policy which is displayed on Council's website and available for inspection at, or from, Council's Customer Service Centres.

This form is to register one person. If you need to register more than one person, when you reach the end of this forum and click 'submit' you will be given the option to register another person.

 
1. Please indicate which session you would like to attend.
  *This question is required.
2. Please provide the following details *This question is required.
Space Cell Details
Name *This question is required
Phone Number
Email address
3. With which gender do you identify
4. What is your age group?
5. Do you speak a language other than English at home?
6. What is your postcode?
8. Do you have any accessibility requirements? (Choose all that apply)