The Victorian Rural Women's Network is a free network which aims to build capacity of rural and regional women through information, opportunities and inspiration. 50places50faces will promote both rural women and the communities they live in.

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* 1. What is your name (if you just want to use your Christian name that is okay)

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* 2. Please tell us in 50 words or less why you love where you live in regional Victoria. Please give the town, district or region that you live in too.

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* 3. Please tick this box below to confirm that you agree to have these words and this image appear on the Victorian Rural Women's Network Facebook page and to be potentially used in other promotions in the future.

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* 4. Now can you please upload an image of you at your farm, home, town or district. Selfies are fine but we do need clear images and we need YOU in it thanks.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 5. Before you leave can you please give us an email or a mobile number just in case we need to contact you. We will not use this for any other purpose.

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* 6. Thanks so much for your involvement. Before you go don't forget if you have not done already, please remember to subscribe to the Rural Women's Network so we can keep in touch on all the great activities, opportunities and stories that interest Rural and Regional Victorian Women.

To subscribe click on this link: https://confirmsubscription.com/h/r/DCE3F7BA1671DCDE

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* 7. Feel free to add any other thoughts or ideas for what the Victorian Rural Women's Network can do for you. Thanks again.

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* 8. And one more thing, if you would like us to tag you into the post when we send it out - add your Facebook or Twitter account details here

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