Expression of Interest to join the Brisbane North Suicide Prevention Network
Thank you so much for showing interest in joining the Brisbane North Suicide Prevention Network.

Once you have completed this form, and in doing so, registered your interest to join the Brisbane North Suicide Prevention Network and to participate in training, you will be contacted by the Lived Experience Coordinator for the Brisbane North area, Martina McGrath. This phone conversation will be an informal opportunity to talk with you about the Brisbane North Suicide Prevention Network, answer any questions you may have, and importantly discuss your readiness to be involved. Whilst it is an informal chat it is also to help ensure that this is both the right opportunity and the right time for you to be involved in this way.

The information you provide in this form will be used for the purposes of discussing your readiness to join the Brisbane North Suicide Prevention Network and to assist with further communication.

Please ensure you have read the ‘Readiness to be Involved in Suicide Prevention’ and 'What is the Brisbane North Suicide Prevention Network' documents before completing this Registration which you can find on our website www.rosesintheocean.com.au under the Lived Experience/Forms page.

http://rosesintheocean.com.au/wp-content/uploads/2018/03/Readiness-to-be-Involved-in-Suicide-Prevention.pdf

Email address *
Support Lines
Should completing this form raise any strong emotions for you, and you'd like to speak with someone, here are some National Helplines:

Lifeline 13 11 14
Suicide Call Back Service 1300 659 467
QLife 1800 184 527

You can find further helplines and avenues of support through the Everymind website here https://everymind.org.au/need-help

First Name *
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Surname *
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Year of Birth *
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Street Address *
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Suburb *
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Mobile Number *
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Alternative Contact Person *
As your safety is our main concern we would like to have a trusted alternative contact for you. In the event that we need to contact a support person for you or are having issues contacting you, we know who to call. Please include their name, relationship to you, and their contact details such as mobile and email.
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Do you identify as a member of any of these groups? *
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Which age range is applicable to you? *
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Please select all that apply to your lived experience *
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Briefly describe your lived experience *
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Please explain what you hope to achieve by joining the Brisbane North Suicide Prevention Network *
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Below are examples of the main activities that the Brisbane North Suicide Prevention Network are involved in. Please check as many boxes as you like to indicate the activity types that interest you the most. *
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Describe what you do on a daily/weekly basis to nurture and take care of yourself. *
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Do you currently access counselling to maintain balance and stability? *
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Please read each statement and indicate your agreement before submitting your application. *
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