Australian Citizenship Ceremonies

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Please complete the form below for Australian Citizenship Ceremony Registration

PLEASE NOTE: The information will be only accessed by authorised council employees. Your information will be not be given to any other person or agency unless you have given us permission or we are required by law.

PERSON/PERSONS MAKING THE AUSTRALIAN CITIZENSHIP PLEDGE

Please ensure you include the full names of all who will be pledging on the day.

Person 1As per current form of identification

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Person 2As per current form of identification

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Person 3As per current form of identification

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Person 4As per current form of identification

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Person 5As per current form of identification

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Person 6As per current form of identification

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Approximate number of guestsNot including those listed above, pledging on the day

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Do you have any special access requirements ?e.g. wheelchair, unable to walk distances etc If so please details below and a staff member will contact you to arrange seating and access.

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Will you be pledging via oath or affirmation ?

Oath (pledge recited on a bible or holy book, you must bring one with you to the ceremony)Affirmation (no bible or holy book required)

During the ceremony the Mayor of Gladstone Regional Council will initiate a hand shake when handing you the Certificate of Citizenship.Do you consent to the shaking the Mayors hand?

YesNo

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Photographic Consent

The Gladstone Entertainment Convention Centre ("GECC”) is collecting your personal information; namely photographs or videos of yourself which may be used in promotional material including videos, catalogues, magazines, newspaper articles, brochures, social media and GECC’s website (“Promotional Material”) The information will only be access by authorised Council employees in relation to the above use and will not be given to any other person or agency other than for the purpose of preparing Promotional Material unless you give us permission, or we are authorised by law.

AGREEMENT TO PHOTOGRAHPIC CONSENTBy ticking the checkbox below I have read and agree to 1. Give the GECC, its employees and those acting with its authorisation the right and permission to copyright, use, and/or publish my photographs and /or the video of myself in the Promotion Material. 2. Waive any right to inspect or approve the finished videos, photographs, advertising copy, or printed matter that may be used in conjunction therewith; or to the eventual use that might be applied; 3. Consent to my personal information being published on GECC’s website as part of the Promotional Material. Access to which will be available outside of Australia.

I agreeI do not agree

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