MUROTO EXCHANGE 2020 – STUDENT DELEGATES

Home / MUROTO EXCHANGE 2020 – STUDENT DELEGATES

Name *

First

Last

Full Name *

As listed on Passport

Date of Birth *

DD/MM/YYYY

Age *

As at April 14th, 2020

Gender *

School *

Year Level *

In 2020

Street Address *

Postal Address *

If same as street address please write "As above"

Email *

Mobile *

Siblings *

Name (gender/age), Name (gender/age), Name (gender/age) etc. - e.g. Luke (Male/17)

Pets *

Name (type), Name (type), Name (type) etc. - Digger (guinea pig)

Hobbies *

Food Likes *

Feel free to write "All"

Food Dislikes *

Feel free to write "None"

Mother's Name

Mother's Occupation

Role at Employer - e.g. Teacher at Port Lincoln High School

Mother's Email

Mother's Mobile

Father's Name

Father's Occupation

Role at Employer - e.g. Teacher at Port Lincoln High School

Father's Email

Father's Mobile

Emergency Contact Person's Name *

e.g. Grandparent/Aunty/Uncle/Neighbour/Family Friend

Emergency Contact Person's Relationship to Student *

Emergency Contact Person's Email *

Emergency Contact Person's Phone *

Preferably mobile phone number

Message