Info Pack
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1

*

Firstname

 

 

 

 

2

*

Surname

 

 

 

 

3

*

Gender

Male
Female

 

 

 

 

4

*

Age Group

 

 

 

 

5

*

Year Level of Study

 

 

 

 

6

*

How Did You Hear About Us

 

 

 

 

7

*

Citizen Status

NZ Citizen

 

 

 

Permanent Resident

     

International

       

8

 

Telephone (Mobile or Landline)

       

9

*

Email Address

       

10

*

Postal address

 

 

 

Street Address

 

 

Address line 2

 

 

City

 

 

State / Province/Region

 

 

Post / Zip code

 

 

Country

       

11

 

Would you like AUT to contact you by phone? (Applies to NZ numbers only)

Yes
No

 

 

 

 

12

*

Study Areas
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