E017 - Request for Keys to the City Applicant Details - Person requesting Keys to the City Title Full Name*This field is required. * Required Field. Community Organisation Address*This field is required. * Required Field. Telephone Number*This field is required. * Required Field. Alternate Contact Number Email Address*This field is required. * Required Field.* Please enter a valid email address. Details of Previous Keys to the City Has a previous Keys to the City been granted? YesNo If YES, please provide details: Details of Keys to the City Function Please describe the following: How the individual or organisation furthered the ideals of the City of Greater Geraldton. Details of the outstanding achievement in sport or humanitarian work at an international level. Details of why request is required. Required date, time and proceeding for the event. Appropriate gift, which could be presented at the event. Supporting information, may be attached at the end of this application before submitting. Details Details of Referees - Person/s who are able to make direct comments about this request Referee One - Title Full Name Community Organisation Address Telephone Number Alternate Contact Number Email Address * Please enter a valid email address. Referee Two - Title Full Name Community Organisation Address Telephone Number Alternate Contact Number Email Address * Please enter a valid email address. Additional Information Any Additional Comments Attach any supporting documentation Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application.*This field is required. YesNo * Required Field. Signature*This field is required. * Required Field. The City of Greater Geraldton collects the personal information you provide in relation to the Request for Keys to the City form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at pris@cgg.wa.gov.au. Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image Was this page helpful? How can we improve this page? Email Address*This field is required. * Required Field.* Please enter a valid Email Address Type the code from the image: Do not fill this textbox.