• Who is submitting this form?

Your Name:
Address:
	State: VIC ACT NSW NT QLD SA TAS WA Postcode:
Contact E-Mail:
Home Phone:	(Please include area code)
Mobile Phone:

• To register you must have a current First Aid Certificate. Please enter the details.
  

  Wilderness Y/N		Expiry Date
  Level 2 Y/N		Expiry Date

• At which University or TAFE college did you study or are you currently studying?

Name of University or TAFE College
Course Undertaken
Other Certificates or Accreditation Held

• Field of expertise or particular outdoor interest
  

   

• Other Experience & References
  

Stirling Experience will confirm receipt within 24 hours. 
Thank you for submitting your contact details to our employment database.

(If your are not comfortable with submitting this information via the Internet or; do not have the facility to do so, then please fill out the above details, print out the page and fax the hard copy to 03 5777 3705.)