safeTALK Suicide Prevention Training – Registration (1 pax) safeTALK registration (ND) June 2024 Intake for Neurodivergent community You can find more details on our safeTALK Suicide Prevention page (opens a new window) If you have any questions, head to our Frequently Asked Questions page (opens a new window) All submissions will remain confidential, and only authorised members of the Equal Dreams team have access to them. Part A: Contact Information Full Name * This will be the name for your certificate of completion Preferred Name * How you’d like to be addressed Email * Contact Number * Part A: Contact Information Full Name * This will be the name for your certificate of completion Full Name of 2nd pax * This will be the name for your certificate of completion Preferred Name * How you’d like to be addressed Preferred Name of 2nd pax * How you’d like to be addressed Email * Email of 2nd pax * Contact Number * Contact Number of 2nd pax * Part B: Getting to know you How are you affiliated with the neurodivergent community? Briefly describe your working and/or academic background * e.g your field of study and/or current sector you are working in Why do you want to join this programme? * Do you require access arrangements? How did you get to know about this programme? Search Engines Equal Dreams Social Media Equal Dreams Mailing List Word of Mouth Part C: Consent I consent to receiving information about new programmes, events or sharing sessions via email. * Yes No I consent to being photographed and having my image and/or likeness used for the purposes of promotional materials, including but not limited to programmes, website content, and social media publicity. * Yes No * I consent to the collection, use and/or disclosure of my personal data by Equal Dreams from time to time, for the purposes of this training programme to Equal Dreams, which includes course administration, collation of feedback, research and analysis, and any other purposes necessary and/or relevant to the above in accordance with the Personal Data Protection Act (PDPA). * I confirm that the data I have provided above is accurate and complete at the time of submission. Payment Please make payment for: safeTalk Registration: $ 30.00 Pax How would you like to pay by? * PayNow (Recommended) Credit/Debit Card Total Payment Payment Information * Submit If you are human, leave this field blank.
