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To The Rescue

Do you know someone in need of some attention?
David and Tanya are making it their mission to answer calls for help and
surprise those in need. So if you know someone deserving fill out the registration form.
We regret that due to the high volume of emails we receive we cannot always respond to each email personally!

Your Name
Your Work Ph
Your Home Ph
Your Mobile
Your Email

Address
Nominee's Name
Nominee's Age
Nominee's Home Ph
Nominee's Mobile
Nominee's Address
Why do they need rescuing?
What do you believe will assist the nominee?
Referees Names & contact details (ie other people that can be contacted in relation to the Rescue request)
Have you approached Radio Newcastle previously with a request for assistance?
Yes
No
Are you able to come to KOFM to collect any elements of your request if KOFM is able to help?
Yes
No
Please email a Medical certificate or documentation confirming situation to davidandtanya@kofm.com.au
This information will be used for the stated purposes only. We will destroy all unused information as well any information that is acted upon. Please read Southern Cross Austereo's Privacy Policy for further information.
 
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