Skip to content
People Bank: tell us about you
Thank you for registering to be a part of the Jean Hailes People Bank.
Your personal information will be handled in accordance with the
Jean Hailes privacy policy
.
You can opt out from receiving communications related to People Bank at any time.
*
Your contact details
(Required.)
Name
*
Email
*
Phone number
*
State
(Required.)
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
*
Which
type of location
best describes where you live?
(Required.)
Metropolitan
Regional
Rural or remote
*
How do you describe your gender?
(Required.)
Female
Male
Prefer not to answer
I use another term (please specify)
*
In what year were you born? (enter 4-digit birth year; for example, 1976)
(Required.)
*
In what country were you born?
(Required.)
Australia
Other (please specify)
*
Do you speak a language other than English at home?
(Required.)
No, I only speak English at home
Yes, I speak another language at home (please specify)
Prefer not to answer
*
Are you of Aboriginal or Torres Strait Islander origin?
(Required.)
Yes
No
Prefer not to answer
*
Do you have a disability (physical, mental, sensory or other types of disability)?
(Required.)
Yes
No
Prefer not to answer
*
Do you identify as LGBTIQA+?
(Required.)
Yes
No
Prefer not to answer
*
What is the highest level of education you completed?
(Required.)
Primary school
Secondary school
Tertiary education (TAFE, university)
Prefer not to answer
*
Where did you hear about Jean Hailes People Bank?
(Required.)
Jean Hailes website
Jean Hailes newsletter
Social media
At a presentation
At my local health service
From a friend or relative
Not sure
Other (please specify)
