Beyond Blue Speaker Registration

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Welcome! In this registration form, we invite you to share some information with us, from your contact details to personal and health information. This helps us assess how well you fit the program and tailor future events to complement your experiences if you become a speaker

Rest assured any information you provide will be securely stored and used in accordance with our privacy policy.

Completing the form may take about 40 minutes to an hour. Please keep in mind, questions about your mental health journey will be asked. Remember to take care of yourself - feel free to take breaks whenever you need as you fill it out.

All mandatory fields are marked with *

Section 1: Personal details

First Name

Surname

Street Address

Suburb

State/Territory

Postcode

Email address

Mobile number

Date of birth

DD/MM/YYYY. Please note, you must by 18 years or older to apply to be a speaker.

Section 2: Professional Background and Networks

This section aims to explore your professional and recreational interests. We'll use this information to match you with speaking engagements that align to your unique experiences.

Current occupation

Do you have a particular interest in any specialty fields from a professional perspective? For example, presenting to workplaces, high schools or community groups?

Response restricted to 255 characters

Please list any groups/organisations you would not like to present to

Response limited to 255 characters

Do you belong to any professional or community associations, either as a member or a volunteer?

Response limited to 255 characters

Section 5: Personal Story Questionnaire

Your responses below will provide the Speakers Team insights to your lived experience. Your responses may become the basis of your personal story that you'll share at speaking events.

Briefly tell us about yourself - your life, family, friends, personal interests, work history and plans for the future?

Response restricted to 255 characters

Why would you like to become a Beyond Blue Speaker?

Response restricted to 255 characters

Are you comfortable sharing your entire personal story as a Beyond Blue Speaker? Is there anything you would not be willing to discuss publicly in regard to your story?

Response restricted to 255 characters

Signs and symptoms

What are the signs and symptoms that you experienced?

Response restricted to 255 characters

What impact did your condition have on your social life or relationships?

Response restricted to 255 characters

Seeking help

What was your turning point to start seeking help? What was your first step?

Response restricted to 255 characters

How did you have your first conversation about your depression and anxiety? Who was it with and how did it go?

Response restricted to 255 characters

Section 6: Personal Story questionnaire (cont.)

Recovery

What does 'recovery' mean to you? What role do you see other people having to you staying 'on track' with your recovery?

Response restricted to 255 characters

What was your turning point? What led to your diagnosis? How did you feel when you were diagnosed?

Response restricted to 255 characters

What happened with your treatment? What worked? What didn't work? Can you give some examples of changes to your life and behaviour after effective treatments?

Response restricted to 255 characters

Have you used the Beyond Blue support service? (phoneline, webchat, online forums or website resources)

YesNo

If you've had a positive experience with the Beyond Blue support service, please describe it below (phoneline, webchat, online forums or website resources)

Response restricted to 255 characters

Resilience

What does your life look like now and how do you manage your condition day-to-day?

Response restricted to 255 characters

What strategies and tools do you use to stay well?

Response restricted to 255 characters

What are your personal warning signs or triggers that you look out for?

Response restricted to 255 characters

Hope

What's the biggest lesson you have learned from your own experiences with anxiety and depression?

Response restricted to 255 characters

What's your advice to someone who is currently experiencing depression and anxiety and not receiving treatment?

Response restricted to 255 characters

What's your advice to someone who is concerned about someone else's mental health?

Response restricted to 255 characters

Is there a book, quote, movie or statement that resonates with you and reflects your mental health journey?

Response restricted to 255 characters

Thank you Page and submit button

Section 6: Confirmation

- I acknowledge that Beyond Blue will collect, use and disclose my personal information in accordance with its Privacy Policy

- I agree to receive email communications from Beyond Blue (you can unsubscribe from this at a later date if you wish)

- I confirm all information I have provided is true and correct

- If successful I am willing to complete a National Police Check

- If successful I am willing to complete a Volunteer Working with Children's Check (or State/Territory Equivalent)

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