Your name *
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0/255
Which Ward do you live in? *
Your age *
Maximum 5 characters
0/5
Your gender *
Your email address
Your phone number *
Community Involvement (you can select more than one) *
What makes you a great candidate for the panel? *
Maximum 20,000 characters
0/20,000
How will you represent your community and ensure a fair, equal and positive outcome for all Hindmarsh residents? *
The deliberative session will be held in one of the Shire's towns. Please provide us information around any additional needs you will have if you are required to travel to/from a town other than the one you reside in to participate in the panel:
