Virtual Trivia Wednesday 30th September, 2020 - 7pm startJoin the Fortem team for a virtual Trivia night with REAL prizes to be won. There are great prizes up for grabs not to mention epic bragging rights! 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 & udpates to this email addressHave 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.Are you registering any additional family members (adults or children) for this activity?Select OptionYesNoPhone *GenderSelect 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 Relative of Serving MemberWhat agency / organisation does the serving member work/volunteer for *Select OptionABFAFPHome AffairsAGDFATState PoliceAmbulanceFire & RescueSESVolunteer FireOtherIf other, please enterWhat is the service status of the member *Select OptionCurrently ServingTransitioning OutFormer ServingAre you registering another adult from your immediate family? *Select OptionYesNoAre theySelect OptionServing Member (Paid)VolunteerPartner of Serving MemberOtherName of the additional person Are you registering any children? *Select OptionYesNoNumber of ChildrenAge of Children (separate by a comma)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 SignaturePhoneSubmit ShareTweetShare
