Application Application Application Your personal detailsLet’s capture your personal details so we can process your application!Your name* First Last Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*Choose an optionMaleFemaleEmail* Address* Address line 1 Address line 2 Town/suburb Choose your StateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Mobile phone*LandlineHow did you hear about us?*Choose oneEmailFriend / colleagueMy HR departmentA TacticianOnline searchOtherMembership typeSelect your membership*Let us know which 12-month membership type you're applying for.Choose onePersonalTeam (Min. of 5 team members)ExecutiveYour Team DetailsPlease list each team member who will receive a membership:Team members*Each team member will receive an email from My Personal Tactician asking their membership objectives and Tactician preferences. Please note that there is a minimum of five members for a team application. Use the (+) icon to add additional rows.NameRoleEmailTeam Manager? Yes Who do the team members report to?Please fill in this item if the team manager is not listed above. A primary Tactician will be allocated to the team, and will liase with the team manager.NameRoleEmailPaying your monthly membership feesTo make life easier, we'll automatically debit your membership fees from your VISA or MasterCard every month. Your membership starts once we've found your Tactician. At this time, you'll receive an email from firstname.lastname@example.org to set up the automatic debit via our online portal.Who will be paying for the membership?*Choose oneMyselfMy CompanyCompany name (if relevant)Company postal address (if relevant) Address line 1 Address line 2 Town/suburb Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Membership agreement*By clicking submit, you acknowledge that you've read and agree to the membership agreement I have read and agree to the terms. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.