This form has been designed to collect some basic information about you when you receive your Energy Safe Victoria LOTO pack, so that Energy Safe Victoria can keep in touch about the kit, and evaluate the program.

To start, please provide your name and email address. This is so that Energy Safe Victoria can contact you with future information and queries specific to the LOTO kit (including some evaluation questions). It will never be used for any other purpose.

Privacy and anonymity
The name and contact details collected through this form will not be used for any purpose other than communications regarding the LOTO program. For further information please view Energy Safe Victoria’s privacy policy. You can also read the collection statement here.