Register your interest with Australia for UNHCR

Please ensure that you complete this enquiry form in full to register your interest with Australia for UNHCR, ensuring that all questions marked with a '*' are answered.

Please be careful when completing all fields as this information will be provided to Australia for UNHCR as part of their decision making process. If you are chosen, you will receive an email notification containing information on how to support Australia for UNHCR.

Do you already have a place in this event? *
Event *
Event Date *
First Name *
Last Name *
Email *
Date of birth *
Gender *
Address 1
Address 2
City/Town
State/Region
Postcode
Country
Contact Phone Number *
Phone Number (Mobile)
Will you be participating in a Wheelchair
Emergency Contact Name
Emergency Contact Phone
Do you have any medical conditions?
Asthma
Diabetes
Allergies
Heart Conditions
Other
Can you provide further details, please.
Why do you want to join our team?
Do you pledge to meet the minimum fundraising target?
How will you meet your fundraising goal?
Please add me to the email list so I can receive Sole Motive newsletters through my email
I agree to the Terms and Conditions and Privacy Policy. *