VAHENonline Registration

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* 1. First Name

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* 2. Surname

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* 3. Do you Identify as Aboriginal and/or Torres Strait Islander?
_{(note: this will be displayed on your VAHENonline profile)}

Yes

Prefer not to say

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* 4. Email

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* 5. What suburb/town do you reside in?

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* 6. What University are you affiliated with?

Australian Catholic University

Deakin University

Federation University

La Trobe University

Monash University

RMIT University

Swinburne University

University of Melbourne

Victoria University

Other (please specify)

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* 7. Which is your home campus?

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* 8. What is your role/job title at the University you are affiliated with?

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* 9. Are you a member of the Weenthunga Health Network?

Yes

No - but I would like to join

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* 10. If you have indicated that you would like to join the Weenthunga Health Network can you please provide your contact number.

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* 11. If you have indicated that you would like to join the Weenthunga Health Network can you please provide your address (including: street number, name, suburb and postcode).

VAHENonline Registration

Question Title

* 1. First Name

Question Title

* 2. Surname

Question Title

* 3. Do you Identify as Aboriginal and/or Torres Strait Islander? (note: this will be displayed on your VAHENonline profile)

Question Title

* 4. Email

Question Title

* 5. What suburb/town do you reside in?

Question Title

* 6. What University are you affiliated with?

Question Title

* 7. Which is your home campus?

Question Title

* 8. What is your role/job title at the University you are affiliated with?

Question Title

* 9. Are you a member of the Weenthunga Health Network?

Question Title

* 10. If you have indicated that you would like to join the Weenthunga Health Network can you please provide your contact number.

Question Title

* 11. If you have indicated that you would like to join the Weenthunga Health Network can you please provide your address (including: street number, name, suburb and postcode).

* 3. Do you Identify as Aboriginal and/or Torres Strait Islander?
_{(note: this will be displayed on your VAHENonline profile)}