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Age-friendly Reference Group Application

Thank you for your interest in joining the City's Age-friendly Reference Group. Please complete the form below to tell us a little about yourself and why you'd like to be involved.

Expressions of interest will be considered as part of the membership selection process. Please note that submitting a form does not guarantee membership.

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Age-friendly Reference Group Membership Application Form

All fields are required except where indicated
 
Note: street number and street name are needed for all addresses
The required criteria is


*Please Note: Only one employee may represent that organisation at each meeting. A proxy may represent that person if the representative is unable to attend.
Your Gender

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City of Cockburn
Whadjuk Boodjar
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 kaditj boodjar kep wer kaadidjiny kalyakool yoodaniny, wer koora wer yeyi ngalak Birdiya koota-djinanginy.

The City of Cockburn acknowledges the Nyungar people of Beeliar Boodjar. 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 Elders, past and present.