Entry form

Please complete the details below.

First Name *

Last Name *

Organisation *

Your Role *

Contact number *

Email *

Would you be willing to participate in any media (including but not limited to the news, video, photography, etc) *

Yes

Which prizes would you like to be in the draw to win * *

St John G5 Fully-automatic Defibrillator with iCPR

St John X3 Semi-automatic Defibrillator

I would like to win either prize

If you receive the defibrillator, will it be registered on the Ambulance Victoria AED Registry? *

Yes

Where will the defibrillator be located?

Location the defibrillator would be placed *

Suburb *

Postcode *

Upload Your Submission

Share how a defibrillator could make a life-saving difference for your community.

You can answer this question any way you like - with a photo, video, audio or written in 25 words or less.

Upload your submission here * Max 40MB size

I have read and agree to the terms and conditions *