Community group and business registration

Thank you for your interest in supporting the Find Doctors For Beechworth campaign.

We ask you to register so that we can provide you with campaign materials that make it is easy to spread the word. Below you will be asked which materials you would like to use. We will then get them to you. We will also use these details to update you and may contact you about stories that come from the search.

The list of registered community groups will also be provided to anyone who does find a doctor for Beechworth but doesn't have connections in our community. They might choose your group!

You can read all the campaign details on our website .

Thank you for your support. In turn, we look forward to being able to support up to three community groups with a $1000 reward each.

Jane Pearce
Practice Manager
Beechworth Surgery

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* 1. What is your community group or business name?

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* 2. Is it a community group or business?

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* 3. Please provide the contact person's name, phone number and email address.

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* 4. For community groups only. How many members do you have?

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* 5. Please tells us which campaign materials you would like to use. You can choose them all.

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* 6. If you have ideas for other ways you would like to promote the campaign through your community group or business, please let us know?

 
50% of survey complete.

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