Registration Form

*  First Name:
    Last Name:
    School / Organisation:
    Postal Address:
    Suburb:
    State:
    Postcode:
    Contact Number:
*  Your Email Address:
    No. of Participants Expected:
    Fundraising Target:
    Please send me a
    Boardies Day Kit:
(please download the resources from our website)
    Please indicate a Surf Life Saving entity
    or Club to be beneficiary of your funds
    (if left blank your valuable funds will be
    directed to priority Surf Life Saving
    needs in your State):
* Preferred Email Format:
*  Enter the security code shown:
    (to avoid spam)