Lodge a Petition

Your Details
First name*
Last name*
Address 1*
Address 2 (optional)
Town/Suburb*
State*
Postcode*
Phone*
Email*
Preferred means of contact*
- Phone
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Petition Details
Petition title*
Open date*
This is the date that you would like the petition to appear on Council's website
DD slash MM slash YYYY
Close date*
This is the date that the petition closes (generally a maximum of 6 weeks but can be less)
DD slash MM slash YYYY
Requested Action*
Briefly outline what action you wish Council to take
Petitioner's Statement*
Provide a clear and concise statement identifying the subject matter
Privacy Statement
Council is collecting this information from you for the primary purpose of communicating with you regarding Council Business. The information will only be used and disclosed as prescribed under the Personal Information Act 2004. The Council requires this information to allow its officers to carry out Council Business. If you do not provide the information requested, Council will not be able to process this form. You may make an application to access or amend the information held by Council by contacting the relevant Council Officer on 6211 8200.

Your Details