Name *

First Name

Last Name

Name *

First Name

Last Name

Permission for Mernda Community House and Whittlesea Community Connections to enter my details into their data bases to be used for statistical purposes *

Agree

Disagree

Permission for Mernda Community House (MCH) and Whittlesea Community Connections (WCC) to use photo’s or videos of me in publications, on MCH and or WCC website and or social media to promote the group and work the organizations do. *

Agree

Disagree

I would like to be updated on Mernda Community House programs and events and give permission to send information via email nominated on this form *

Keep me updated

No updates