Panel registration form

An important part of our community consultation is our panel…people from all age groups, areas and occupations who like to contribute their ideas and opinions, as a survey respondent or as a participant in a small group discussion.

If you would like to join our panel for research groups and surveys, please complete the following.


Name:
Phone:
Mobile:
Email:
Suburb:
Age:
What is your occupation?:
Are you
single married with partner
Do you have children?
Yes No
What are their ages:
Are they living with you?
Yes No
If you heard about us from a friend or family member...
What is their name?
And what is their relationship to you?

Thankyou for your interest.