2025 Laos Storm Co – AUC Simple Events

Team Member Registration

2025 Laos Storm Co – Team Member Form

First Name

Last Name

Date of Birth

Street Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Date Travel Commences

Date Travel Ends

Postal Address – if different to street address above

Address Line 1

Address Line 2

City

State

Post Code

Country

Medical Information

Please note that we will only use this information should you require medical assistance and you are unable to provide the information yourself at the time of the event.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Street Address

Alternative Emergency Contact Name

Alternative Emergency Contact Relationship

Alternative Emergency Contact’s Phone/Mobile

Alternative Emergency Contact Street Address

Doctor’s Name

Doctor’s Phone/Mobile

Doctor’s Clinic

Blood Group (if known)

Do you suffer from any of the below (please select all that are relevant)

Allergies or intolerances

Anaphylaxis

Angina

Asthma

Diabetes

Epilepsy

High Blood Pressure

Low blood sugar

Other (please detail in the section below)

I do not have any notifiable conditions

Please provide details on your allergies/intolerances and how they are managed.

Please provide details on what causes anaphylaxis and how a reaction is to be managed.

Please provide details on how you manage your angina.

Please provide details on how your asthma is managed and anything we need to be aware of.

Please provide details on how your diabetes is managed and anything we need to be aware of.

Please provide details on how your epilepsy is managed and what we need to be aware of.

Please provide details on how your blood pressure is managed and what we need to be aware of.

Please provide details on how your low blood sugar is managed and what we need to be aware of.

Please provide details on OTHER notifiable conditions.

Agreements & Safeguarding

I have read and agree to the Code of Conduct.

Please select which of the following you have (must still be valid)

Working with Children Check

AdSafe Awareness Training

AdSafe Code of Conduct

I do not have any of the above

AdSafe Awareness Training Certificate

Choose File

AdSafe Code of Conduct Certificate

Choose File

Working With Children Check

Choose File

Optional uploads – any medical plans, travel documents, etc.

Choose File