Expression of Interest Registration

About You

Please complete this 5 minute survey to register your interest in attending CaPSS' programs.

The Salvation Army is committed to caring for people by protecting personal information and upholding the Australian Privacy Principles. To read our privacy policy please visit salvationarmy.org.au/privacy. By providing us with your personal information or by using the website, you are confirming your agreement to the content of our privacy policy.

Note: if you would like to register interest on someone else's behalf, please email capss@salvationarmy.org.au to ask for a referral form.

Question Title

* 1. What is your First Name?

Question Title

* 2. What is your Last Name?

Question Title

* 3. Gender

Question Title

* 4. Address

Address *

Address 2

Suburb *

Question Title

* 5. State/Territory

Question Title

* 6. Postcode

Question Title

* 7. Email address and phone number (for links and reminders)

Email Address

Phone Number

Question Title

* 8. How do you prefer to be contacted?

Phone call

Text message

Question Title

* 9. What is your date of birth?

Date / Time

Date

Question Title

* 10. Do you identify as either Aboriginal or Torres Strait Islander

Aboriginal

Torres Strait Islander

Both Aboriginal and Torres Strait Islander

Neither

Question Title

* 11. Were you born in Australia?

Yes