Ben Kavanagh Public Art Project - Registration Form

To register your interest please fill in the below form.

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1. Are you a resident of Mordialloc?

Yes

Option 1

No

Option 1

2. If you answered No to the above question, what is your connection to Mordialloc or the local Mordialloc community?

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YOUR DETAILS

Full Name (i.e. John Smith) * (required)

Email address* * (required)

Postcode* (Note: you do not need to reside in Kingston to participate) * (required)

Contact telephone number * (required)

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CONSENT DECLARATION

I consent for my contact details to be given to Kingston City Council to contact me regarding my registration. * (required)

Yes, I consent.

Would you like to subscribe to our monthly eNewsetter? * (required)

Type the characters you see in the picture below (Required)