MANDURAH

NEIGHBOURHOOD WATCH

Please print out a copy of this application form, complete, and mail to us.

REGISTRATION FORM

Last Name (Mr Mrs Ms):.....................................................................(LAST NAME)

Other Names: .............................................................................................

Address: .....................................................................................................

                ........................................................................Postcode:...........................

Telephone:(Home)............................................(Work).............................................

Mobile: ........................................................Email:....................................................

  Participants Signature:............................................................................................

Date:............../........./...................

================================================================

(NB. Persons registering for Street Representatives, Area Co-ordinator or Suburb Manager positions ONLY are required to complete this section).

Motor Vehicle Driver's Licence No. ................................................................................

Date of Birth.    ......................../............/....................

                                    PLEASE RETURN TO

Mandurah Neighbourhood Watch

1 Pinjarra Road

MANDURAH   WA   6210

OR Post to:

PO Box 1508

Mandurah   WA   6210

                                                    Roles

Suburb of ..................................................................................

(One Suburb) 

To promote and manage N.H.W. in their suburb, in consultation with their Crime Prevention officer

(Area within Suburb) 

To promote and encourage N.H.W. in their suburb with their Suburb Manager

(One Street) 

To promote and encourage N.H.W. in the street in consultation with their Area Co-ordinator

All other applicants

 

Please circle your selection above..... 

[ Home ] [ Up ]

Copyright © 2010 MANDURAH NEIGHBOURHOOD WATCH

Telephone:    08 9581 4182