| Community Online Registration Form | |
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| Event name: | |
| Community group/workplace | |
| Title | |
| First name: | |
| Last name: | |
| Phone 1: | |
| Phone 2: | |
| Postal address: | |
| Suburb: | |
| State: | |
| Postcode: | |
| Email address: | |
| Event description: (max. 50 words) | |
| Walk commencing from: | |
| Starting date of event: | |
| Concluding date of event: | |
| Please indicate the days your event will be held (e.g. daily, weekdays, Mondays, etc) | |
| Time commencing: | |
| Time concluding: | |
| Anticipated number of participants: | |
| Is the event open to the public? | Yes |
| | No |
| | |
| Will you invite media to attend? | Yes |
| | No |
| | |
| Would you like more information on Heart Foundation Walking? | Yes |
| | No |
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| Your t-shirt size: | |
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