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Team Captain Registration Details 

You will now be asked to enter your personal details, those of your team and your team members. This registration might take a few minutes. You can return at a later date to amend or update details as required, via the Team Management area, so please take note of your login and password. However, please note, that your team registration is ONLY complete once your full payment is confirmed.

Team captain registration details

*Please complete the following fields. All information is required.

Key
Title*
First Name*
Last Name *
Your Email Address *

You can use the same username and password to manage your teamTrekker Login, or to manage your fundraising in the Fundraise Login
Confirm Email Address *
Create account password *

You can use the same username and password to manage your teamTrekker Login, or to manage your fundraising in the Fundraise Login
Confirm accout password *
Your Mobile Number *
Your Street Address *
Suburb *

Please enter the first 3 letters of your suburb.
Enter at least 3 letters of the suburb
State *
Postcode *
Country
Your Gender *
D.O.B *
I would like to receive email updates about Wild Women On Top     Yes
I would like to receive email updates about The Fred Hollows Foundation's work     Yes
I would like to receive mail updates about The Fred Hollows Foundation's work     Yes
Your personal details will be shared with event partner The Fred Hollows Foundation, for the purpose of setting up your team and individual fundraising pages. *     Yes
As the person registering your team, you are assumed to be the Team Captain *     Agree
Have you participated in Coastrek before? *
I acknowledge that I have read and agree to the Coastrek Rules and Guidelines.
I acknowledge that the Registration Fee is non-refundable or tax deductable *		    Agree
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