Online Form - Nomination Form - Keirnan Park Stakeholder Reference Group

To submit an online nomination for the Keirnan Park Stakeholder Reference Group, please fill out the form below.

Full name *

Street address *

Suburb *

Email *

Phone number *

Please provide a summary of your background within the Shire of Serpentine Jarrahdale community and your interest in being involved in the Keirnan Park Stakeholder Reference Group. *

Please provide a summary of your involvement with other professional or community groups and your experience of working within a team environment. *

Please provide a summary of any qualifications you have obtained that are relevant to Keirnan Park Stakeholder Reference Group. *

Please provide any other information to support your application for the Keirnan Park Stakeholder Reference Group.

Please upload any supporting documentation you wish to provide

Maximum size of ALL attachments is 976.56 MB

I have read the Keirnan Park Stakeholder Reference Group Terms of Reference. *

Yes