Metro South Health - Register for Zika Mozzie Seeker

Given name *

Family name *

Business name (if you're from a business or child care centre)

Unit number (if applicable)

Street number *

Street name *

Suburb *

Postcode *Make sure your address information is correct so you get your egg collection kit.

Email *

Mobile number *

Can we send you SMS and email reminders and updates during the round?

YesNo

Have you collected a mosquito egg collection kit from your local library or health centre?

YesNo

We'll send you a free egg collection kit if you don't have one.

Do you consent to some of your mosquito eggs being sent to the Mosquito Genomics Lab (QIMR Berghofer Medical Research Institute) for other DNA testing?

YesNo

No personal information (such as your name, address, email address or phone number) will be shared outside of Queensland Health as per the Information Privacy Act 2009 (Qld).

What is the barcode number of your kit?

Where did you collect your kit?

How did you hear about us?

Why do you want to take part in Zika Mozzie Seeker?

If you selected 'Other' from the participation response above, please provide details *