USU

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 *

Personal Details

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*

Captcha Code