Community Directory Registration form

Fill in this form to be included in the Town of Bassendean's Community Directory. Please complete the details below to ensure that our records are correct:

* required fields

Organisation Details
Has your Community Group been listed in the Directory before?
	No Yes
Trading name*:
Title:	Mr Mrs Ms Miss Dr Prof
First name:
Surname:
Position:	(eg. Manager, President, Director, Treasurer)
Street address:
Suburb:
Postcode:
Postal address:
Suburb:
Postcode:
Phone:
Facsimile:
Mobile:
Email*:
	(leave email address as is if you don't have one)
Website (URL):
Nature of activity:
What we do:

Related Links:

Community Directory Registration form