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Connect & Protect - Alice Springs application form

Join Connect and Protect

Sections marked with * must be completed. Your details contained within this form are confidential and are for verification purposes by Alice Springs Police only. Any information contained on your own Facebook account is subject to the Facebook privacy conditions.

Your details

Name

Alice Springs residential address

Suburb

Postcode

If you are not an Alice Springs resident but feel you can contribute to this online crime prevention partnership, please provide your address and reasons for wanting to join. Attach supporting documentation if necessary.

Attachment if required

Valid NT Drivers Licence number

Date of birth

Please provide a contact telephone number - mobile or landline

Email address

Personal Facebook Username (‘organisations’ cannot be accepted into the group in accordance with Facebook policy)

Terms and conditions

I have read and agree with the terms and conditions stated below

Yes

Terms and Conditions:

I agree that the above information is true and correct.

I agree that I will not use any profanities, degrading, sexist, racial or personally offensive/defamatory comments while I am involved in the Connect & Protect – Alice Springs group.

I agree not to disclose or divulge any information pertained within the Connect & Protect – Alice Springs group.

I agree I will partake in the online forum regularly and constructively.

I agree to the above conditions and agree that if I fail to comply with any of them, I may have my Facebook profile removed from the group.