Apply now and you could win $1000 cash! It only takes a minute to apply, and if your successful, you could be testing heaps of Durex products and provide your honest feedback!

Please complete all fields:

Name:
Address (You must be an Australian resident to apply)
Number and Street:
Suburb:
State:
Postcode:
Gender	male female
Date of Birth:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 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 day month year
How often do you use condoms?
Every day Once a month Twice or three times a week Every couple of months Once a week Once or twice a year Once a fortnight Never
What brand of condoms do mostly use? (tick all that apply)
Durex Vixens by Cottons Ansell Glyde Four Seasons Other, please specify:
How did you hear about the Durex Condom Tester promotion?
Got an email Heard it on the radio Read it in the newspaper Found it on the internet/blog Word of mouth Heard it from a promotional team at a nightclub/bar
Tell us why you want to be a Durex Condom Tester?
The funniest applications will be posted on the Durex website each week, under your user ID so your identity will be anonymous.
User ID:
If your application is successful how would you like us to contact you?
By telephone, my number is: By email, my address is: By post, my address is: By fax, my number is:
Durex reserves the right to use parts of your application for publicity purposes. All applications will be kept strictly confidential and anonymous. Click here to review our privacy policy