Application for membership of the Dubbo City Youth Council

Personal details

Title* - required

First name* - required

Surname* - required

Contact number* - required

Email address* - required

Date of birth

Address line 1

Address line 2

Suburb/City

State

Postcode

Is your mailing address the same as the address above?* - required

Yes No

Mailing address

Address line 1

Address line 2

Suburb/City

State

Postcode

Signature* - required

Please type your signature

Please sign here

Parent/guardian’s details (if applicant aged under 18)

Name* - required

Address* - required

Telephone* - required

Email* - required

Parent/guardian’s signature* - required

Please type your signature

Please sign here

About You

Tell us about your education (school, TAFE, University, workshops, training etc)* - required

Are you currently working? Please give some details* - required

Do you have interests/hobbies outside school/study/work? (eg. volunteer work, sport, creative arts, Scouts/Guides, cadets etc)* - required

Have you received any awards or prizes, or had any other recognition of achievements you have made? Please give some details.* - required

Do you have any special areas of interest?* - required

Mandatory field(s) marked with *

Last Edited: 10 Jan 2020

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