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Become a HeadFirst Hero
Sign up today to join our campaign for mentally safer workplaces!
7
Questions
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1
Name:
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First Name
Last Name
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2
Email:
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example@example.com
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3
Phone:
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4
Which state do you work in?
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New South Wales
Queensland
South Australia
Tasmania
Victoria
Western Australia
Australian Capital Territory
Northern Territory
New South Wales
Queensland
South Australia
Tasmania
Victoria
Western Australia
Australian Capital Territory
Northern Territory
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5
What is the name of your workplace/worksite?
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6
How do you want to help the campaign?
Share a survey with my workmates
Sign a petition online
Share a petition in my worksite
Tell my story to others
Join a Facebook Group
Attend a Campaign rally/event
Become an HSR
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7
Are you an HSR/Delegate at your worksite?
Yes - Delegate
Yes - HSR
No
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8
Get Page URL
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9
Other ways you want to get involved:
Test fjc
Test fjc2
Please Select
Test fjc
Test fjc2
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10
Referrer
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11
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