Rogaine and Inward Bound Registration Form
This form registers you as a potential competitor in Inward Bound AND for both ACTRA Rogaines. Your entry will be confirmed once your coach nominates you for a division/team.

The information you submitted here will be used to:
- pre-register you for Inward Bound 2017
- provides us with the information to register you for ACTRA 3hr Twilight rogaine and 5hr Nightgaine (your entry for both of these events will still need to be confirmed by your coach)

Please complete the information required as accurately as possible. It should only take 5 minutes of your time.

NOTE: This form cannot be changed after you submit it. If you put in the wrong information, you will need to complete the form again.

Full Name *
Your answer
Date of Birth *
DD/MM/YYYY (ie. 01/05/1922)
Your answer
University ID *
(use uXXXXXXX if not an ANU or SRA member)
Your answer
Affiliation *
What college/hall do you represent?
What year at college are you? *
Or, if ex-resident, choose "Ex-Resident"
Gender *
Contact Information
Preferred Email Address *
Your answer
Contact Number *
(Preferably a mobile)
Your answer
Postal Address *
Your answer
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