Title
First Name *required
Last Name *required
Address *required
Email *required
Phone
Mobile
Preferred method of contact Email Mobile Phone
How many adults live in your household? Please select... 1 2 3 4 >4
How many children live in your household? Please select... 1 2 3 4 >4
What facilities do you enjoy most at Bingara Gorge?
Do you know about the Resident Referral Program? Please select... Yes No
What would you like to improve at Bingara Gorge?
Are you or any of your household interested in helping organise any of the following? Please select... Resident Welcome Events Arts & Crafts markets Community Garden Book Club Volunteering Church Music Groups Sporting clubs and groups
Please list any other areas you or members of your household are interested in organising which are not listed above.
What educational institutions do members of your household currently attend? Childcare Wilton Public School Other K-6 school High School, Yrs 7-12 TAFE / University Online education None
Do any members of your household have intentions of attending the following institutions in the future? Childcare Wilton Public School High School, Yrs 7-12 TAFE / University Online education None
How far do you commute for work? Please select... 0-20 minutes 21-40 minutes 41-60 minutes 61-80 minutes 81-100 minutes Over 121 minutes
How far do students in your household commute? Please select... 0-20 minutes 21-40 minutes 41-60 minutes 61-80 minutes 81-100 minutes Over 100 minutes
Are you a member of the Community Portal at www.bingaragorgeonline.com.au? Yes No
If you are a portal member, how often do you check the portal for information? Please select... Daily Weekly Monthly Rarely
What would make the community portal a more useful resource for you?
Which of the following do you read / attend / check for news about Bingara Gorge Community Update Newsletter Community Noticeboard at the Sales and Information Centre Resident Welcome Events Community Portal Facebook
Are you self-employed? Please select... Yes No
Do you work from home? Please select... Yes No
If so, would you like us to include you in our Community Business Directory on the portal? Please select... Yes No
Mandatory field(s) marked with *required