| *indicates required field |
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1 | * | Firstname | |
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2 | * | Surname | |
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3 | * | Gender | Male
Female |
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4 | * | Age Group | |
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5 | * | Year Level of Study | |
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6 | * | How Did You Hear About Us | |
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7 | * | Citizen Status | NZ Citizen |
| | | Permanent Resident |
| | | | International |
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8 | | Telephone (Mobile or Landline) | |
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9 | * | Email Address | |
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10 | * | Postal address | |
| | Street Address | |
| | Address line 2 | |
| | City | |
| | State / Province/Region | |
| | Post / Zip code | |
| | Country | |
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11 | | Would you like AUT to contact you by phone? (Applies to NZ numbers only) | Yes
No |
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12 | * | Study Areas
To make multiple selections hold down 'CTRL' |
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