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Albert Eden and Puketāpapa Eco- Neighbourhoods Registration Form
Registration for Albert-Eden and Puketāpapa Eco Neighbourhoods
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* Indicates required question
Group Name (if any)
If you are registering as an individual who is not part of a group do not enter a group name
Your answer
Are you a group contact person?
*
Only answer yes if you have entered a group name and you are the contact person for the group
Yes
No
First Name
*
Given name
Your answer
Last Name
*
Family name
Your answer
Preferred Phone Number
*
The phone number you prefer to be contacted on
Your answer
Alternative Phone Number
*
A different phone number you can be contacted on if you can't be contacted on your preferred phone number
Your answer
Best Time to Contact You
*
What times of day/days of week are the best times to contact you?
Your answer
Email
*
Your preferred email address
Your answer
House Number
*
Unit/apartment number (if any) and street number
Your answer
Street
*
Road you live in
Your answer
Please state which local board area you reside in? Please give the exact suburb. For example, Waterview in Albert-Eden or Hillsborough in Puketāpapa.
*
Your answer
How did you hear of Eco Neighbourhoods?
*
Select one or more options
Neighbourly.co.nz
Facebook
email
Central Leader
poster/flyer
event
other (please specify below)
Required
Other way you heard of Eco Neighbourhoods?
Answer this question if you answered other to the previous question
Your answer
Which of your contact details do you give permission to be shared with other interested people who live close to you?
*
Select one or more options
Name
Preferred Phone Number
Alternative Phone Number
Email
Address
None
Required
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