1 Start 2 Payment If you would like to use our CHF We’re #withconsumers Tick for your next national or international event, publication or initiative, please complete the form below and allow up to ten working days for a reply. Name Prefix - None -MrsMsMrDrMissProfHonAssoc ProfAdj Prof First Name * Last Name * Name of Organisation * Street Address Street Address Line 2 City Postal Code State/Province Country * Australia Phone Number * Phone Number 2 Phone Extension 2 Email * Is your organisation a * - Select -Not for profitCommercial enterprise Name of event, publication or initiative claiming the CHF We’rewithconsumers Tick status * Dates during which you will be using the We'rewithconsumers Tick - Start Date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year201920202021202220232024 End date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2019202020212022202320242025 Please provide a statement explaining how the Tick will be used. * Existing Contact URL of event, publication or initiative claiming the CHF We’rewithconsumers Tick status Hashtag of event, publication or initiative claiming the CHF We'rewithconsumers Tick status List examples that demonstrate how the event, publication or initiative is collaborating/engaging with consumers. Please provide evidence, including links. * Please provide a statement demonstrating how your organisation’s goals align with CHF’s mission and objectives. * Supporting Documents Files must be less than 2 MB.Allowed file types: gif jpg png. Leave this field blank
