First name
Surname
Contact number
Email address
Address
Suburb
State —Please choose an option—ACTNSWQLDSATASVICWAInternational
Postcode
Emergency contact - name
Emergency contact - number
Emergency contact - relationship
Do you have any food allergies?
Special dietary requirements
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yes I have read, understood and agree to the Camp Widow Australia code of conduct.
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I agree and provide my photo consent:YesNo
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