FORTEM REGISTRATION FORM Please enable JavaScript in your browser to complete this form.First Name *Last Name *Email *Use an email address you can access from home. We’ll be sending the event details & updates to this email addressPhone *Have you previously completed this form for a Fortem activity?Select OptionYesNoNote: registration for this activity will not be confirmed until full details of participants are received. If you are unsure, please select “No”and fill out the below form again.How did you hear about Fortem? *Fortem PresentationWorkplace Wellbeing TeamColleagueFamily or PartnerFriendWebsite / Social MediaOtherGenderSelect OptionFemaleMaleOtherPrefer not to sayAgeSelect Option18 – 2526 – 3536 – 4546 – 5556 – 6566+SuburbState *Select OptionACTNSWVICQLDSAWANTTASOverseas postingPostcode *Are you primarily a *Select OptionServing Member (Paid)VolunteerPartner of Serving Member Family of Serving MemberWhat agency / organisation does the serving member work/volunteer for *Fire & RescueVolunteer FireForest Fire Management (Victoria)AmbulanceState PoliceMarine RescueESTA 000SESVolunteer Rescue Association (VRA)ABFAFPHome AffairsDFATAGWhat is the service status of the member *Select OptionCurrently ServingTransitioning OutFormer ServingAre you registering any additional adults from your family/ inner circle? *Select OptionNo123Name of Adult 1 *FirstLastTheir relationship to you *Are they… *Select OptionServing Member (Paid)VolunteerPartner of Serving MemberImmediate Family MemberName of Adult 2 *FirstLastTheir relationship to you *Are they… *Select OptionServing Member (Paid)VolunteerPartner of Serving MemberImmediate Family MemberName of Adult 3 *FirstLastTheir relationship to you *Are they… *Select OptionServing Member (Paid)VolunteerPartner of Serving MemberImmediate Family MemberAre you registering any children from your family/ inner circle? *Select OptionNo1234If you would like to register more than 4 children from your family, please contact activities@fortemaustralia.org.au to make your request.Name of Child 1 *FirstLastAge *Name of Child 2 *FirstLastAge *Name of Child 3 *FirstLastAge *Name of Child 4 *FirstLastAge *NewsletterYes, subscribe me to the monthly newsletterCode of Conduct *I have read, understood and agree to comply with the Code of ConductPrivacy Policy *I acknowledge that I have read and understood Privacy Policy and consent to my personal information being collect, used and disclosed by Fortem Australia as described in the Privacy PolicyWaiver *I consent to, have read, and agree to the WaiverSignature *Clear SignatureWebsiteSubmit FIND A WELLBEING ACTIVITY LEARN ABOUT OUR APPROACH ShareTweetShare
