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