Register Online


Full Name
Preferred Name
Postal Address
Suburb
Postcode
Date of Birth
Phone (h):
Phone (w):
Phone (m):
Fax:
Email
I am
I am interested in being involved with:
Please choose...
Elders
Youth
Men's Group
Women's Group
Burrai Play Group
Volunteering
Activities I would like to participate in:
Please choose...
Cultural Activities
Cultural Education
Arts & Crafts
Computers
Reconciliation
Volunteering
Music
Nutrition
Employment Programs
Other
Volunteer skills that I can offer
Please choose...
Arts & Crafts
Computers
Exercise Classes
Education & Training
Cultural Skills
Bus Driving
Other
Further Comments:
Verification Code:
Reload image
Enter Verification Code :

* = Required Fields

 

Print Form & Post

Download and print this form and post to:

Mullum Mullum Indigenous Gathering Place Ltd
PO Box 80
Ringwood East  Vic  3135

To Mullum Mullum's Community News

MMIGP_registration.pdf MMIGP_registration.pdf (83kB)