(Guests) QUT eSports Member Registration

Tell us about yourself

Name

First Name

Last Name

Contact Details

Email
Phone	Mobile

Mailing address

Date of birth

Gender

Female

Male

Prefer not to say

Other

Desired username

Please provide your desired username to use to access QUT eSports' facilities.

How did you hear about us

Facebook

Friends

QUT eSports Website

Other

Please pay (via QUTPay) your eSports membership with the link below and enter your receipt number in the next field.

NOTE: After payment, please add your payment's receipt number in the next field.

Receipt Number

e.g. QUT123456

Member Information