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Name
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Date of Birth
Who is your Mob (Include Nation, community & family?
Where do you currently live?
Option 1:
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Option 2:
Tell us a little about yourself (written option- 400 words max)
Why do you want to be part of IRONMOB program?
What is your understanding of what the IRONMOB program is/does?*
How did you hear about the IRONMOB Program?
Social Media (Facebook, Instagram, etc.)
Program Website/Online Ad
Referral from a Family, Mob Friend/Colleague
Community Event
Local Newspaper/Print Media
Other
How are you currently involved in your First Nations community?*
If selected how would you use this journey to inspire other First Nations people?
What impact would this journey have on your family or community?
How do you currently look after your health and wellbeing (physical, emotional, spiritual)
What physical activities do you currently do each week?
Do you have any injuries or health considerations we should know about?
What would success look like for you at the end of IRONMOB program?
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Strava Profile Name
First Nations Community Referee (Please include the following: Name, phone number, email, relationship to you)
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