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What community group are you putting forward?
Name
*
Suburb
*
State
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Other
Which MHFA course are you interested in?
Youth
Adult
How many people are you expecting to do the course?
*
Tell us in 100 words or less why your community would like to take up this opportunity
*
*
When would you like to hold the course?
First Preference
*
*
Second Preference
*
Your contact details
Name
*
*
First Name
Last Name
Email
*
*
*
