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Please fill out the form below to receive a "Keeping Kids at Secondary School" application form via email.

Note: If you do not receive an email within two hours, please contact the Chances team on 03 5023 5966.

First Name*:
Last Name*:
Email Address*:
Town:
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Post Code* (4 digits only):

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Mildura Office:
Haselgrove House
122 Ninth Street Mildura
T: (03) 5023 5966