Tap 2 Distract Promotional Material Request Form
Help us share the life-changing impact of Tap 2 Distract with the world.
Name
*
First Name
Last Name
E-mail
*
example@example.com
Mobile Number
*
Format: 0000 000 000.
Organisation/Business Name
*
Organisation/Business Type
*
Please Select
Hospital
Medical Centre
Emergency Service
Childcare Centre
School
Corporate
Other
Address
*
Street Address
Street Address Line 2
Suburb/Town
State
Post Code
How will you be using the Tap 2 Distract promotional material?
*
Do you agree to send TLC for Kids a photo of the displayed promotional material?
*
I agree
Do you consent to TLC for Kids using your organisation/business name and/or photographs for any social media or promotional content?
*
Yes
No
Submit
Should be Empty: