PAPYRUS Supporters
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1
. What is your first name?
What is your first name?
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2
. What is your last name?
What is your last name?
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3
. What is your email address?
What is your email address?
4
. What is your full address including postcode?
What is your full address including postcode?
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5
. What is your date of birth?
What is your date of birth?
6
. I am interested in..
I am interested in..
Being part of a regional network to raise funds
Being trained to develop life saving suicide prevention skills
Sharing my personal story with the media team
Volunteering occasionally in the Warrington Office
Representing PAPYRUS at regional events
Sharing my opinion as a young person (under 35)
7
. Are you following us on Facebook?
Yes
No
Facebook
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Are you following us on Facebook? Facebook Yes
Facebook No
Twitter
Twitter Yes
Twitter No
8
. Please choose which region you would most associate with yourself
Please choose which region you would most associate with yourself
North West England
North East England
South West
South East
South Yorkshire
North Yorkshire
West Midlands
East Midlands
East England
Greater London
West Scotland / Glasgow
East Scotland / Edinburgh
Highlands / Aberdeen
Northern Ireland
South Wales
North Wales
Mid Wales
Outside of the UK
9
. We are sensitively trying to update our database. If you have been affected personally or been bereaved by suicide, and are able to share the details, please fill in the following questions.
Name of the deceased
We are sensitively trying to update our database. If you have been affected personally or been bereaved by suicide, and are able to share the details, please fill in the following questions. Name of the deceased
Name of the deceased
Year of death
Age
Relationship to you
10
. Thank you for your help. If you have any further comments, please use the box below.
Thank you for your help. If you have any further comments, please use the box below.
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