Registration For Vaccine Injured Australians

This registration page is only for Australian residents who have experienced a COVID-19 vaccine injury (including parents/guardians of under 18yo vaccine injured residents). Everyone else should use one of the other registration methods.

• First Name* If you are uncomfortable providing your real name, enter an alias
• Last Name
• State ACTNSWNTQLDSATASVICWA
• E-mail*
• Password* Minimum length of 8 characters.
  The password must have a minimum strength of MediumStrength indicator
• Repeat Password*
• I understand and agree to the website Terms & Conditions and Privacy Policy, and I confirm that I am at least 18 years of age.*