Beac nomination application form

Banyule Environment Advisory Committee Application Form Please complete this form and return to: Fleur O’Luanaigh Banyule City Council PO Box 51 IVANHOE VIC 3079 fleur.oluanaigh@banyule.vic.gov.au www.banyule.vic.gov.au GREENSBOROUGH 9 –13 Flintoff Street Normal Council Hours Of Opening 8.30am-5.00pm Monday to Friday 9.00am-12.00 Noon Saturday

1.

Telephone 03 9457 9828 Facsimile 03 9499 1391 DX: 97904 Ivanhoe TTY No. 03 9432 7211 for the hearing impaired IVANHOE 275 Upper Heidelberg Road Normal Council Hours of Opening 8.30am-5.00pm Monday to Friday

ROSANNA 44 Turnham Avenue Normal Council Hours of Opening 8.30am-5.00pm Monday, Tuesday, Thursday & Friday 8.30am –7.00pm Wednesday

Name Address

Phone

H)

W)

Email Age

15-25 

(Please tick appropriate box)

2.

25-35 

35-45

45+ 

Please list any relevant community groups, clubs or associations that you have been involved with and in what capacity.

Club/Organisation

Role

3.

What skills/area of expertise do you have that will contribute to fulfilling the role of this Committee?

4.

One of the purposes of this Committee will be to assist with the implementation and review of Council's Environment Strategy. What key issues in relation to the Strategy do you wish to pursue?

5.

Is there any other relevant information that you would like to provide in relation to your application to this Committee?

6. Please attach your resume.

Please return completed application and resume to: Fleur O’Luanaigh Environmental Officer Banyule City Council PO Box 51 Ivanhoe 3079 Email: fleur.oluanaigh@banyule.vic.gov.au

Applications due 3 March 2013 Enquiries – Fleur O’Luanaigh - 9457 9828

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I …………………………………………………………. understand that the information provided above will be used (please print) in accordance with relevant legislation and declare that this information is correct to the best of my knowledge.

Signature: ………………………………………………………

Date: ………………………………