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City of Boroondara

8 Inglesby Road
Camberwell VIC 3124

(03) 9278 4444
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(03) 9278 4466
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CIS Online Registration Form

Type your organisation's details into the form below. Mark clearly any details you do not wish to be made available for public viewing by inserting an asterix (*) next to the text.

Please click 'Submit' when the form is complete.

Organisation Details

Full name of organisation: *

Abbreviated name (if applicable):

Parent Body (if applicable):

Postal Address: *

Street Address:

Telephone: *

Fax:

Email address:

Venue name (if different from above):

Venue address:

Disability access?: Yes
No

Website address:

Contact details

Contact name 1: *

Contact 1 Address: *

Contact 1 Telephone:

Contact 1 Fax:

Contact 1 Email:

Contact Name 2:

Contact 2 Address:

Contact 2 Telephone:

Contact 2 Fax:

Contact 2 Email:

Organisation Information

Organisation objectives or purpose:

Service or programs offered:

Hours of operation:

Target group (eg. children, older people):

Eligibility criteria:

Referral Process:

Fees: Yes
No

If yes, please give details:

Main funding source:

AGM month:

Created: 25 February 2006
Last Update: 28 April 2008

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