Full Name*

Email Address

Name of Business*

Business Type*
---OfficeAccommodation Retail
Due to the research nature of this trial only these three business categories are currently eligible for an assessment. Please call the office on 5479 1900 if you would like to clarify whether your business falls into one of these three categories.

Preferred Contact Number*

Postal Address

Street Address (if different from postal address)

Municipality
---Buloke ShireCampaspe ShireCentral Goldfields ShireCity of BallaratCity of Greater BendigoGannawarra ShireHepburn ShireLoddon ShireMacedon Ranges ShireMount Alexander ShireNorthern Grampians ShirePyrenees ShireRural City of AraratRural City of Swan Hill

Reason for Contact

The Central Victoria Solar City Consortium would like to contact you with details of special offers on products and services, competitions, and details of community events that may be relevant to you. By ticking this box, you consent to be contacted by the Central Victoria Solar City Consortium by email and/or mail until you decide to opt out, or until the Central Victoria Solar City initiative is completed on 30 June 2013, whichever is earlier. This opt-in applies for this purpose only and does not affect any other terms and conditions that provide for individual members of the Central Victoria Solar City Consortium to contact you.

Opt-in?
 Yes No