Registration - Gaia International

Gaia International City - Registration
$50 USD inc taxes

Name*

First Last

Gaia International City - Registration

Upload a clear Headshot for use on our Gallery Page*

Maximum upload size 8MB

Email*

Date of Birth*

Your FaceBook URL

Instagram

Twitter

Cell Number (please add country code)*

Untitled*

Cell Number*

e.g. +61 400 555 555

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Category you are entering

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Confirmation

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I acknowledge I am giving permission to Gaia International to use my profile headshot in the public domain*

*Not limited to Gallery, Competition Winner Announcements, Media releases, Social Media (Facebook, Instagram, Twitter) and blogs.

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By clicking Pay Now I agree to pay the registration fee and understand I will be directed to PayPal to complete my registration.

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Name of Guardian*

Cell Number*

Phone

This field is for validation purposes and should be left unchanged.