First Name |
|
Last Name |
|
Email |
|
Gender
|
Male
Female |
Date of Birth |
|
Address |
|
Suburb or Town |
|
State |
|
Postcode |
|
Daytime Contact |
|
Mobile |
|
Gotcha Call Idea
|
Victim's Name |
|
Victim's Date of Birth |
|
Victim's Work Phone |
|
Victim's Mobile Phone
|
|
Does the victim listen to NXFM? |
Yes
No
Not Sure |
How would you best describe the victim?>
|
Gullible
A hothead
Constantly suspicious |
|
|
The information supplied
will be used solely for the purpose of considering whether
to use it in a Gotcha Call and all information will
be deleted after that consideration
|