First name *
Last name *
Date of Birth
Mobile phone *
Email address *
Postal Address *
Please select your surf life saving club *
Collection Statement: Surf Life Saving Queensland (SLSQ) collects your personal information to communicate information and offers from SLSQ, and to provide SLSQ products and services directly with you. By providing your personal information you agree it will be disclosed to, and used by, Surf Life Saving Queensland under the terms of this statement and SLSQ Privacy Policy (http://lifesaving.com.au/about/disclaimers-legal-notices/). SLSQ may disclose your personal information to other parties, including SLSQ third party service providers. SLSQ may use and disclose your personal information for direct marketing purposes, unless you opt out (which you can do at any time in accordance with the SLSQ Privacy Policy).