New Signee Survey
RequiredRequired Question(s)
Welcome to this survey as a new signee to the Canberra Declaration!

Please note that this survey is optional. Even so we earnestly hope you will take a few minutes to complete as much of it as you can. 

That way we will get to know you better as an individual and what issues are of concern to you. As well we can get a better understanding of the Canberra Declaration community as a whole. 

We also ask you about ways that you would like to be involved as a member of the Canberra Declaration community.

All information will be kept confidential by the Canberra Declaration.
 
About you
 
1.
What is your gender?

Male
Female
2.
Which category describes your age?

Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
3.
Which of these best describes your church affiliation? You can add further details of your denomination in the comments box.

Catholic
Protestant
Orthodox
Pentecostal
Evangelical
Christian but not affiliated to any local church
Agnostic
Belong to another world religion
Other  
  • Comment:

  • 500 characters left.
4.
The Canberra Declaration works in partnership with other like-minded Christian organisations. To which of these do you already belong?

Australian Christian Lobby
Australian Prayer Network
Family Voice Australia
Endeavour Forum
Australian Family Association or National Civic Council
None
Other  
  • Comment:

  • 500 characters left.
Issues that concern you
 
5.

Please indicate how concerned you are about different issues in regard to Religious Freedom


If there is something not on the list that you are highly concerned about use the comment box to tell us.

 Highly Concerned Very Concerned Slightly Concerned Not Concerned  
Preserving our Christian Heritage  
Freedom of Religion  
Freedom of Speech  
Freedom of Conscience  
Multiculturalism  
Militant Islam  
The Progressive Left  
Changes to Our Constitution  
  • Comment:

  • 500 characters left.
6.

Please indicate how concerned you are about different issues in regard to Marriage and Family


If there is something not on the list that you are highly concerned about use the comment box to tell us.

 Highly Concerned Very Concerned Slightly Concerned Not Concerned  
Attempts to Redefine Marriage  
Sexual Purity  
Pornography  
Divorce  
Drug and Alcohol Abuse  
Bullying  
Domestic Violence  
Paeodophilia  
  • Comment:

  • 500 characters left.
7.

Please indicate how concerned you are about different issues in regard to the Sanctity of Human Life.  


If there is something not on the list that you are highly concerned about use the comment box to tell us.

 Highly Concerned Very Concerned Slightly Concerned Not Concerned  
Abortion  
Euthanasia  
Embryo-destructive Research  
New Reproductive Technologies  
Changes to the Medical Profession  
Capital Punishment  
Human Trafficking  
Genocide  
  • Comment:

  • 500 characters left.
We need you!
 
8.
Do you have any suggestions or creative ideas to help the Canberra Declaration community grow in numbers and getting involved? If 'Yes' please write the details in the comment box.

Yes
No
  • Comment:

  • 500 characters left.
9.
Would you be interested in joining a Prayer Team which prays for the ministry of the Canberra Declaration?  If 'Yes' we will start sending prayer team updates about once a month.

Yes
No
10.
Would you be interested in promoting the Canberra Declaration (in your church, with a particular group or at an event etc.) as an Advocate?  If 'Yes' we will contact you to see how we can support you.
 
Yes
No
11.
Would you be willing to become a Volunteer in any of the following areas? (You can tick more than one!)  NOTE: Most jobs can be done from wherever you are by computer with whatever time you have available.  Our offices are in Wollongong and Brisbane.

Sharing on Social Media
Helping with Website Work
Phoning other Signees
Doing Artwork or Design
Organising a Meeting in My Location
Entering Data
Helping with Mailouts
Writing Letters, Blogs or Submissions
Helping with Fundraising
Helping with Administration
Other  
  • Comment:

  • 500 characters left.
12.
Would you be interested in becoming a Donor to the ministry of the Canberra Declaration?  If 'Yes' we will contact you. 

Yes I would like to make a one-off donation
Yes I would like to give on a regular basis
No not at this time
13.
Which social media do you use?
 
None
Facebook
Twitter
Instagram
Other  
  • Comment:

  • 500 characters left.
14.
Would you be interested in meeting with other members of the Canberra Declaration community in your suburb or town?

Yes
No
  • Comment:

  • 500 characters left.
Your answers to the final three questions are required in order to link your responses to your signing details. Your information will be kept confidential.  
 
Required 15.

Please type your First Name and Last Name.

 

50 characters left.
Required 16.

Please enter the email address that you used to sign the Canberra Declaration.

 

50 characters left.
Required 17.

Please enter your post code.

 

50 characters left.
Thank You!