Entry in the State Register of Heritage Places - Goldfields Water Supply Scheme - Page 1 of 4 - WA DPLH

Introduction

1. What is your name?

Name

2. Do you consent to your position on this registration being made available to other stakeholders?

Yes No

3. What is your email address?

4. Are you responding on behalf of an organisation?

(Required) Yes No

If yes, please state your organisation