Register – Butterfly Collective

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Introduction

As a Butterfly Collective member, you will have access to a members only online area where you can:

View and take part in activities designed to inform Butterfly’s work
View and express your interest to take part in opportunities run by other relevant organisations (e.g. research studies, focus groups etc)
Keep updated on the latest sector news
Learn about the experiences of other members of the community

Providing Butterfly with the following information will enable us to personally invite you to take part in opportunities that are relevant to your unique experience. Some of the opportunities may only be relevant to community members with specific backgrounds or experiences. This may include, for example, a research study on the experiences of carers, or a particular diagnosis or behaviour.

Your Details

Username*

Email*

Password*

Enter Password Confirm Password

Name*

First Last

Mobile Phone*

Street Address*

City*

State*

Post Code*

Mailing Address

City

State

Post Code

About You

Date of Birth*

DD slash MM slash YYYY

What was your sex recorded at birth?*

Other sex at birth*

How do you describe your gender (which may be different to sex recorded at birth and may be different to what is indicated on legal documents)?*

Other term to describe your gender*

Were you born with a variation of sex characteristics (sometimes called intersex or DSD)?*

Hidden

How would you describe your sexual orientation?*

Heterosexual/straight

Gay

Lesbian

Bisexual

Pansexual

Asexual

Don’t know

Prefer not to say

I use a different term (please specify)

Other sexual orientation*

Do you identify as Aboriginal or/and Torres Strait Islander?*

Do you speak a language other than English at home?*

Other language*

What is your ancestry?

English

Irish

Scottish

Italian

German

Chinese

Indian

South African

Vietnamese

Iranian

Indigenous Australian

Other (please specify)

Don’t know

Prefer not to say

Other ancestry*

Do you identify as a person with a physical disability?

What is your current/most recent occupation?*

Other occupation*

About your experience

Please indicate who your experience of body image concerns, disordered eating and/or eating disorder primarily relates to:*

How would you best describe your experience, or the experience of a family member/friend you support? (Please select all that apply)

Body Image concerns

Disordered eating

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

Specified Feeding and Eating Disorders (OSFED)

Avoidant/Restrictive Food Intake Disorder (ARFID)

Unspecified Feeding or Eating Disorder (UFED)

Rumination Disorder

Orthorexia

Compulsive exercise

Pica

Other (Please specify)

Other*

Do you have any other health conditions (Please include physical and mental health)*

If you mentioned yes to above and feel comfortable, please briefly outline any other health conditions you experience*

If you are comfortable, please use the next section to briefly describe your personal experience and tell us why you would like to join the Collective*

Your Interests

Please tell us more about the type of activities you would like to participate in as a member of the Butterfly Collective

Informing Butterfly’s work

Informing the work of the broader eating disorder sector and mental health sector

Advocating for people experiencing eating disorders, body image concerns and/or disordered eating and their carers

Contributing to podcast and newsletter content

Contributing to blogs

Contributing to Butterfly’s social media campaigns

Contributing to research and evaluation

Getting involved in committees and advisory groups

Contributing to co-design activities and working groups

Where did you hear about us?*

Butterfly Foundation newsletter

Butterfly website

Butterfly social media

From Collective member

Another organisation

Word of mouth

Online

Prefer not to say

Signup

Yes I would also like subscribe to receive Butterfly’s other communications (approximately 2 emails a month)

Confirmation

Your information will remain confidential and only be accessed by Butterfly for the purpose of registering you as a member of Butterfly Collective and inviting you to take part in opportunities to contribute to our work. You may request access to your information at any time.

By clicking on the submit button below I acknowledge that:

Butterfly will collect, use and disclose my personal information as described above and in accordance to Butterfly’s Privacy Collection Statement
Butterfly will regularly be in touch with me by email relating to the Butterfly Collective and other activities as indicated in my registration.
I will notify Butterfly if my contact details change or I no longer want to be a member of the Butterfly Collective.
The information I have provided is true and correct.
If I find any of the content or activities to be triggering, I can opt out at any time to prioritise my own mental health and wellbeing

Name

This field is for validation purposes and should be left unchanged.