Team, Class or House Fund Raising Registration

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* Indicates required question

Email *

Your email

Name of the Team, Class or House *

Your answer

The team will be participating in what fund raising activities? *

Name or describe the activity(ies)

Your answer

Your Name as contact person *

Your answer

Your email address *

Your answer

Your contact telephone number

Your answer

Any comments or questions?

Your answer

Security Question

Characters from first image *

Your answer

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This form was created inside of The Business Physician Pty Limited.