Focus Group Nomination | The City of Vincent

1.

Full name

* required

Maximum 255 characters

0/255

2.

Email

* required

3.

Phone number (optional)

Maximum 255 characters

0/255

4.

What is your connection to the Leederville town centre?

Select all that apply.

* required

I live in Leederville

I work in Leederville

I own property in Leederville

I own/manage a business in Leederville

I visit Leederville regularly

I study in Leederville

I'm a member of a community group in Leederville

Other (please specify)

5.

Please tell us briefly why you'd like to be part of the community focus group.

* required

6.

Please confirm you are available to attend the first two workshops which will be held at the City of Vincent Administration Building:

Workshop One - Wednesday 12 March at 5pm (1.5hrs)

Workshop Two - Wednesday 19 March at 5pm (1.5hrs)

Note: catering will be provided.

* required

Yes, I am available for both

I am only available for Workshop One

I am only available for Workshop Two

Other (please specify)

7.

Please tell us if you are:

* required

Male

Female

Prefer not to say

Other (please specify)

8.

Which age range are you?

* required

16-29

30-39

40-49

50-59

60+

Prefer not to say