Climate Action Art Competition Entry Form First Name: (required) Surname: (required) Email:(required) Phone: (required) Postcode: (required) Where do you hear about this competition? (required) search engine Facebook Instagram Radio Friends Word of Mouth local library Other Please choose one of the following categories for your entry. (required) Mixed-media (at least 1 piece of plastic 'waste' and 1 piece of organic materials) Photography Are you in the North Sydney electoral division? (required) Yes No Your Age Group(required) 10 – 13 14 – 17 18 – 25 Are you of Aboriginal and/or Torres Strait Islander descent?(required) Yes No Prefer not to say Do you speak a language other than English at home?(required) Yes No Prefer not to say What is are your ethnic identity/identities?(required) Indigenous Australian Asian East Asian Hispanic/Latino African European Eastern European Pacific Islander Prefer not to say Other What is your gender identity? (required) Male Female Non-binary Prefer not to say Other Within Australia/New South Wales, where do you think climate action is urgently needed?(required) What are some feasible actions to take within Australia/NSW?(required) On a scale of 1-10 ('1' being 'it is not all important to me' and '10' being 'it is very important to me'), how important is climate change/action to you?(required) 1 2 3 4 5 6 7 8 9 10 On a scale of 1-10 ('1' being 'It does not affect me at all' and '10' being 'It affects me greatly'), how much do politicians' actions and stance on climate change affect your voting decision/perception of them?(required) 1 2 3 4 5 6 7 8 9 10 If you are in the North Sydney Electorate, please answer the following questions: Within North Sydney, where do you think climate action is urgently needed? What would you like the North Sydney MP Hon. Kylea Tink to do for climate action within North Sydney? What are some feasible actions to take within North Sydney? On a scale of 1-10 ('1' being 'I don't trust Hon. Kylea Tink' and '10' being 'I totally trust Hon. Kylea Tink'), how much do you trust the current North Sydney MP Hon. Kylea Tink to take effective climate action? 1 2 3 4 5 6 7 8 9 10 What would you like Hon. Kylea Tink to do for climate action within North Sydney? Is there anything else you would like to tell us (Community Flower Studio) or Hon. Kylea Tink? Thank you for completing this entry form, please proceed to the Online Shop to pay for the entry fee ($5) here. Please click ‘calculate delivery’ and choose ‘local pick-up’ (No delivery fees will be charged). Registration is complete after payment has been received. Submit Δ
