Expressions of Interest - Pride in the Paddock
About You
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Best contact time? (select all applicable)
morning
afternoon
other
If other please describe
Which best describes you? (select all that apply)
LGBTIQA+ farmer
LGBTIQA+ agricultural worker
LGBTIQA+ rural community member
Health professional
Agriculture industry professional
Ally
Other (please specify)
If other please describe
Are you over 18 years of age?
Yes
No
Do you live in a farming community?
Yes
No
Town
Postcode
State
Your Experience:
Please briefly describe your connection to farming or rural communities.
Why are you interested in contributing to Pride in the Paddock?
Do you have lived experience relevant to LGBTIQA+ inclusion in farming communities?
Would you like to be added to our monthly e-news? *
Yes
No
Consent statement
I consent to being contacted by the National Centre for Farmer Health regarding participation in Pride in the Paddock. I understand that my information will be used only for project‑related communication and will be kept confidential.
Yes
No
Submit
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