Personal Information

Title *	-- Mr Mstr Mrs Ms
First Name *	First Name should match passport/identification
Preferred First Name
Last Name *

Home Address

Country *	Australia Christmas Island Cocos Islands Cook Islands Fiji New Zealand Papua New Guinea Samoa Solomon Islands Tonga Vanuatu You must be a resident of the countries listed to join Velocity
Home Address *
Suburb/Town *
State*	Select State ACT NSW NT QLD SA TAS VIC WA Australian residents only
Postcode *	Australian and NZ residents only

Is your postal address different than your Home Address

Postal Address

Country *	Australia Christmas Island Cocos Islands Cook Islands Fiji New Zealand Papua New Guinea Samoa Solomon Islands Tonga Vanuatu
Postal Address *
Suburb/Town *
State *	Select State ACT NSW NT QLD SA TAS VIC WA Australian residents only
Postcode *	Australian and NZ residents only

Other Information

	*You must provide at least one phone number
	Phone		Please include country and area codes
	Mobile
Make sure you correctly enter your email address, as this will be your key to receiving great offers from Velocity and its Partners.
* E-mail address
* Re-enter E-mail address

Security Information

Date of Birth *

-- 01020304050607080910111213141516171819202122232425262728293031 ---JanFebMarAprMayJunJulAugSepOctNovDec ---- 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

*Password		for use on the Velocity website
*Re-enter Password
Security Question *	What is your mother's maiden name? Who did you have your first kiss with? Who is your favourite sporting team? What was your first pets name ?
*Security Answer

Terms & Conditions

I have read and agree to be bound by the Terms & Conditions. and declare that the details that I have provided in relation to this Velocity Membership application are true and correct

By joining Velocity Rewards you consent to the Velocity sending you: your monthly Points Balance Statement, periodic Velocity Exclusives, Virgin Blue Group Airline Updates, Travel Partner Offers, Other Partner Offers, Member Updates and market research.

You may unsubscribe from these communications at any time by either amending your My Preferences found in My Account or by clicking the unsubscribe link provided on the communications.

Security Image

Please enter the letters in the image exactly as you see them. All letters are lowercase.

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The issuer is Velocity Rewards Pty Ltd ACN 116 089 448 (as trustee of the Loyalty Trust) at 56 Edmondstone Road, Bowen Hills, QLD 4006.