Disability Reference Group Membership Form

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Please note: Submitting an expression of interest does not guarantee membership. The City of Cockburn Disability Access & Inclusion Officer with be in contact regarding your application.
Print Form

Disability Reference Group Member Nomination Form

All fields are required except where indicated
 
Note: street number and street name are needed for all addresses
Group Members (please select any which apply):



Do you give permission for digital photos to be taken of yourself by the City of Cockburn or any of its authorised agents during your membership to the Disability Reference Group:
Photos taken may be used by the City for any internal and external purposes i.e. newspapers, posters, printed newsletters, billboards and online media.

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Contact

Address

City of Cockburn
Whadjuk Boodja
9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Office opening hours:
8.30am to 4.30pm
Monday to Friday (excluding public holidays)

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Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaditj boodjar kep wer kaadidjiny kalyakool yoodaniny, wer koora wer yeyi ngalak Birdiya koota-djinanginy.

City of Cockburn acknowledges the Nyungar people of Beeliar boodja. Long ago, now and in the future they care for Country.
We acknowledge a continuing connection to land, waters and culture and pay our respects to the Elders, past and present.