FremantleMind Inc. Registration Survey 2021-22

To Be Completed Once Only

FremantleMind Inc. require all attendees to complete a registration survey at their first mental health and wellbeing promotion event.

The registration survey is required to be completed once only.

FremantleMind Inc. will disseminate a request for the completion of a follow up feedback survey in three months time.

The team at FremantleMind Inc. greatly appreciate you taking your time in answering all questions in the survey. The registration survey will take around five minutes to complete.

All information provided is confidential.

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* 1. Your Details

Full Name

Postal Code

Email Address

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* 2. What is your date of birth?

	Day	Month	Year
Date of Birth	Date of Birth Day menu	Date of Birth Month menu	Date of Birth Year menu

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* 3. What is your country of birth?

Australia

Other (please specify)

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* 4. Is English your first language?

Yes

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* 5. Do you identify as Aboriginal or Torres Strait Islander?

Aboriginal

Torres Strait Islander

Neither

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* 6. What is your gender?

Female

Male

Other (please specify)

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* 7. Do you identify with any of the following religions? (Please select all that apply.)

Christianity

Judaism

Islam

Buddhism

Hinduism

Inter/Non-denominational

No religion

Other (please specify)