Directory Registration form

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

* required fields

Choose a Directory Type
Which Directory do you wish to be listed in?*
	Town of Bassendean Community Directory
	Town of Bassendean Business Directory
Has your Community Group or Business been listed in the Directory before?
	No Yes
Organisation Details
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 business or activity:
What we do:

Related Links:

Directory Registration form