Your Contact Information First name:	* required
Last name:	* required
Suburb:	* required
Postcode:	* required
State:	NSW
Email Address: We may email you from time to time regarding groups that are available	* required
Email Check Frequency:	Hourly - Read Emails Hourly Daily - Read Emails Daily Weekly - Read Emails Weekly
Telephone - Home:	* required
Telephone - Work:
Telephone - Mobile:	* required
Group Area Preferred:	City City & North Sydney City & Hurstville Hurstville North Sydney Parramatta Any Areas
Questions about You Your Gender:	Male Female
Date of Birth:	* required
Marital Status:	Defacto/Living with Partner Divorced Married Single Widow
Do you have any children? If so what is their year of birth? Child BOY, Year of Birth: (yyyy)
Child BOY, Year of Birth: (yyyy)
Child BOY, Year of Birth: (yyyy)
Child GIRL, Year of Birth: (yyyy)
Child GIRL, Year of Birth: (yyyy)
Child GIRL, Year of Birth: (yyyy)
Employment Status:	Full Time Part Time Self Employed Student Home Duties Unemployed
Job Title:
What Industry Type?:	Accountant Arts Architect Bank Builder Casino Charity Childcare Construction Consultant Council Customs Design Education Engineer Education Fashion Finance Government Healthcare Hospitality Hotel Insurance Info Technology (IT) Manager Manufacturing Marketing Media Medical Professional Other Police Publisher Property Recruitment Retail School Security Shipping Superannuation Tafe Teacher Telecommunications Tourism Transport Travel University Other
Your Occupation: (ABS Codes)	Professional: ie. Doctor, Dentist, Solicitor, Account Semi Professional: ie. Specialised Technician, Teacher, Nurse Skilled: ie. Qualified Tradesperson Clerical: ie. Office Work Retail: ie. Sales, Shop Assistant Apprentice / Trainee Business Executive Manual Work House-Wife / House-Husband Student Retired / Other Unemployed
Annual Household Income Category:	Under $10,000 per year $10,000 - $19,990 per year $20,000 - $29,990 per year $30,000 - $49,990 per year $50,000 - $69,990 per year $70,000 - $89,990 per year $90,000 or more per year
Credit Cards: (Choose whichever applies)	American Express Bankcard Debit Card Diners Mastercard Store Card Visa Other
Your Main Bank:	ANZ Bank of Queensland Bankwest Bendigo Citibank Commonwealth HSBC IMB ING Macquarie National Australia Bank St George Suncorp Teachers Credit Union Westpac Other Bank
What types of Accounts do you have?:	Savings Cheque Investment Web Savings
These questions relate to your main vehicle(s) Car Make(s):
Car Model(s):
Year of Manufacture:
Car Insured With?:
Is this a Company Car?:	Yes No
About Your Mobile Phone Service Mobile Provider:	AAPT Optus Orange Telstra Virgin Vodafone Other 3
Mobile Plan:	Post Paid (Under Contract) Company Supplied Pre-Paid
Additional Information Do you Drink?: (Choose whichever apply)	Beer Pre-Mixed Spirits Wine Non Drinker
Do you smoke Cigarettes?:	Non-Smoker Alpine Benson & Hedges Brandon Cambridge Camel Dunhill Holiday Horizon Kent Longbeach Marlboro Menthol Pall Mall Peter Jackson Peter Styvesant Roll your own Rothmans Stradbroke Wills Winfield Other
What mg?:	2mg 4mg 8mg 12mg Other
Do you have Pets?:	Bird Cat Dog Fish Other
Do you own a Personal Computer?:	Yes No
Do you wear Glasses/Spectacles/Contact Lenses?:	None Glasses Hard Contact Lenses Soft Contact Lenses Glasses & Contact Lenses
Do you travel on Business?:	Yes No
Do you have Pay TV?:	No Austar Foxtel Optus Other
Do you have Private Health Insurance?:	No - Do not have Private Health Insurance Employer HCF MBF Medibank Private NIB Other