I hereby agree that all information entered into the fields of this form is valid and accurate. I understand that providing information of a false or untrue nature may lead to a penalty. I hereby confirm that my full legal name is that as entered into field 8. By completing this form and checking the 'I confirm that I have read and understood the above agreement' checkbox below this agreement and clicking the 'Process form' button at the bottom of this page I am aware that all of my information will be electronically processed and sent via electronic mail (E-mail) to two (2) email addressing of the organization operating under the name of 'Cape Mic', hereafter refered to as 'Cape Mic'.

Cape Mic holds no responsibility/warranty/guarantee/control over this electronically sent information from the point that it leaves this page until the point it arrives as a newly delivered mail to the two (2) email addresses it is sent to. Information leaving this page is handled by various server technologies at various locations during its course of delivery and' Cape Mic' has no part in this delivery process whatsoever and therefore voids itself of all responsibilty for the processed form information UNTIL it reaches the intended recipients. Once the information has been duly received by 'Cape Mic' the information will be kept confidential at all times and used as intended by 'Cape Mic' for whichever purpose they feel beneficial to them, the organization.