Register for Australia's Healthiest Workplace 2017

Please complete your details below to register for Australia's Healthiest Workplace 2018.

First name:

Last name:

Phone number:

Email address:

Job title:

Other:

Organisation Name:

Contact address (work):

Head Office Location (if different to above):

Organisation Size (number of employees):

Industry:

Other:

Do all of your employees have access to a work e-mail address?:

Please select if your organisation operates across a number of sites and you would like to compare results across these locations
(Optional, maximum 5)

Name of Location 1:

Name of Location 2:

Name of location 3:

Name of Location 4:

Name of Location 5:

How did you hear about AIA:

Other:

Please tick this box to confirm you have read and consent to:

The terms and conditions on behalf of your organisation and consent to be contacted for purposes of Australia’s Healthiest Workplace by AIA Vitality;
The collection, use (including handling and storage) and disclosure of the information provided in this form by AIA Australia Limited in the manner described in its Privacy Policy (as updated from time to time), including exchanging this information with the providers of Australia’s Healthiest Workplace by AIA Vitality that may be located in Australia or overseas; and
Retail Employees Superannuation Pty Limited (Rest) as trustee of the Retail Employees Superannuation Trust and its representatives, receiving a copy of the information you have submitted through this registration page, and consent on behalf of your organisation to Rest for the purposes of Australia’s Healthiest Workplace by AIA Vitality conducting or participating in activities and events and receiving other information relating to your organisation’s participation in Australia’s Healthiest Workplace by AIA Vitality (personally identifiable responses to the survey will not be provided to Rest).

Please tick this box to confirm you have the authority to register your organisation for this initiative