Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

*

I am a trained White Ribbon Ambassador/Champion

The organisation I represent has policies and procedures in place to support young people who engage with the Youth Advocate Programme (such as what to do if someone makes a disclosure)

I understand that the details I have submitted in this form will not be passed to third party organisations, and will only be used to facilitate the Youth Advocate Programme in my organisation.

If your organisation is White Ribbon Accredited, what date did you achieve this? (MM/DD/YYYY)

MM

DD

YYYY

Would you like to receive more information about becoming a White Ribbon Accredited organisation? *

Yes

No