Required fields are marked with an asterisk (*).

Contact Name *

Email *

State or Territory *

• QLD
• NSW
• ACT
• VIC
• TAS
• SA
• NT
• WA

Organisation where you work

Name of Team in which you work (this will be your team name for the challenge and printed on your certificate)

Sector/Organisation Type *

• Public Mental Health Service
• Private Mental Health Service/Hospital
• Community-managed/non-government organisation
• Primary care/PHN-funded service
• Other

Service Setting

• Inpatient
• Community/ambulatory
• Residential

Consumer Age Group

Select all age groups your team work with and want to participate in

• Child & Adolescent
• Adult
• Older Person