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First Name *

Last Name *

Phone *

Email Address *

Country / Region *Australia

Street address *

Apartment, suite, unit, etc. (optional)

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State * Select an option…Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia

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I give consent to Barista HQ to use my photo/video captured in the class for their social media purposes *YesNo