Presenter Registration

To register as a presenter, please take the time to fill out the information below.

First Name

Last Name

Email

Mobile

Address

Town

Postcode

Region

What region are you from?GascoyneGoldfields-EsperanceGreat SouthernKimberleyMid-WestPeelPilbaraSouth WestWheatbeltInterstate

What is your age range?

Choose your age18 - 2425 - 3435 - 4455 - 6465+

Company Name

What is your gender

Choose an optionMaleFemaleOther

Do you identify as Aboriginal or Torres Strait Islander?

Choose an optionYesNoPrefer not to say

Are you a member of the Country Music Club of Boyup Brook?

Choose an optionYesNo

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