1. Litter Reporter number*
2. Title*
3. First Name*
4. Last name*
5. Date of birth*

   Please use the format dd/mm/yyyy (for example 01/12/1970)

6. Street number and name*
7. Suburb*
8. Post Code*
9. State
10. Council/Shire*
11. Home phone number
12. Mobile number*
13. Email address*
14. Occupation
15. Anything else we can help you with?

    If you would like to share any other information about your Litter Reporter status, please record here.

Interested in volunteering opportunities?

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If you would like to be contacted for volunteering opportunities as they arise, please check this box.

* denotes a required field.