Kokoda Challenge : Register

Create Account
Create Your Page
Optional Donation

Joining School/Workplace Palmview State Secondary College

I'd rather just register as an individual

New Participant
Returning Participant

Personal Details

First Name *

Last Name *

Email Address *

Password*

Phone *

Date of Birth *

Gender *

Male Female Other

Shirt Size *

Residential address

(enter address manually)

UnitStreet Number *

Street *

City *

Postcode *

State *

Country *

Emergency Contact Details

Please provide us with an emergency contact

First Name *

Last Name *

Contact Number *

Relationship to you

Additional Questions

Do you want to share your story for potential media opportunities?

Where did you hear about us? *

Other

Terms & Conditions

Yes, I agree to the terms and conditions *

Yes, I agree to all outlined cut off dates and fundraising minimums *

Yes, I have read and understand the contents of the acknowledgement, waiver, and release form *