V TEAM Registration Form

Account Setup

What is your Working With Children's Check Number

First Name *

Last Name *

Preferred Name

Are you a domestic or international student? *

What is your USU Member Number? *

Email Address *

Confirm Email Address *

Password *

Confirm Password *

Birth Date *

Mobile Number *

Gender*

Address *

Address Line 2

City *

Postcode *

State/Territory*

Emergency Contact Name *

Emergency Contact Number *

Secondary Emergency Contact Number

Relationship to you*