Multicultural Reference Group Membership Application Form

Please complete details and answer all questions in the form below. The information you provide will assist us in ensuring a diverse range of participants are represented in this group.  
Submitting an expression of interest does not guarantee membership. All applicants must reside within the City of Cockburn. 

Print Form

Multicultural Reference Group Membership Application Form

All fields are required except where indicated
Note: street number and street name are needed for all addresses
Will you be available to attend monthly meetings? (optional)?:
What is your preferred time to meet? (optional):

Do you require childcare? (optional):

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City of Cockburn
Whadjuk Boodja
9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Office opening hours:
8.30am to 4.30pm
Monday to Friday (excluding public holidays)

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Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaadatj dayin boodja, kep wer malayin. Ngalak kaadatj koora koora wer yeyi ngalang birdiya.

City of Cockburn acknowledges the Nyungar people of Beeliar boodja. Long ago, now and in the future they care for Country.
We acknowledge a continuing connection to land, waters and culture and pay our respects to the Elders, past and present.