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Step 1

Team Captain Registration Details 

To enter your team you are required to register yourself (as the captain), create your team and add your team members.

You can return at a later date to complete your entry or amend the details of your team or members details via logging into the website.

Please note: Your team registration is only complete once your full payment is confirmed.

Team captain registration details

*Please complete the following fields. All information is required.

Team captain Team member 2 Team member 3 Team member 4
Title*
First Name*
Last Name *
Email Address *
Confirm Email Address *
Create Account Password *
Minimum 6 characters
Confirm Account Password *
Mobile Number *
Street Address *
Suburb *
Enter at least 3 letters of the suburb
Postcode *
State *
Country
Gender *
Personal Fundraising Goal $
D.O.B *
Age Range *
Have you participated in Coastrek before? *
I acknowledge that I have read and agree to the Coastrek Rules and Guidelines. *    Agree
I acknowledge that the Registration Fee is non refundable and non tax deductible *    Agree
I give permission for The Fred Hollows Foundation to contact me with information about their work *

I would like to receive email updates about Wild Women On Top     Yes
Your personal details will be shared with event partner The Fred Hollows Foundation, for the purpose of setting up your team and individual fundraising pages. *     Yes
As the person registering your team, you are assumed to be the Team Captain *     Agree
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