VAHENonline Registration
*
1.
First Name
(Required.)
*
2.
Surname
(Required.)
*
3.
Do you Identify as Aboriginal and/or Torres Strait Islander?
(
note: this will be displayed on your VAHENonline profile
)
(Required.)
Yes
No
Prefer not to say
*
4.
Email
(Required.)
5.
What suburb/town do you reside in?
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)
7.
Which is your home campus?
8.
What is your role/job title at the University you are affiliated with?
*
9.
Are you a member of the Weenthunga Health Network?
(Required.)
Yes
No
No - but I would like to join
10.
If you have indicated that you would like to join the Weenthunga Health Network can you please provide your contact number.
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).
Current Progress,
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