| Title | |
| First name | |
| Family name | |
| If you are representing an organisation on Listening Post, please tell us its name | |
| Are you the person solely or jointly responsible for paying rates to Auckland City Council for a property you own? | |
| Street address | |
| Suburb | |
| City | |
| Country | |
| Your e-mail address (please check carefully as this is how we will correspond with you) | |
|
We would like you to provide us with some optional personal information to help us understand the range of responses we receive from the Listening Post membership and ensure that we make your Listening Post participation as easy as possible. |
|
| Which gender are you? | |
| What year were you born? | |
| To ensure we provide for members' needs at Listening Post consultation events, please indicate any facility (such as wheelchair access or a hearing loop) that needs to be available for you to take part. | |
| Which ethnic group(s) do you belong to? | |
| Which language(s) are spoken in your home? | |
| Including yourself, how many people usually live in the same house or apartment as you? | |
| What is your household's (or apartment's) annual income? | |