Refer a Friend (Current)

Your details
Please enter your details below so that we can send you $250 when your friend is dosed in a trial.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Date Of Birth*

DayMonthYear
You need to be 18+ years of age
Age
Please confirm:*

I have read and understood the Refer a Friend (https://www.linear.org.au/refer-a-friend/) terms and conditions
Please confirm:*

I give Linear permission to retain this information to contact me for future trial.
Date

DayMonthYear
Date

New participant details (Your friend)

Please enter the details of the friend you are referring to Linear below!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Please confirm which statement is true:

My friend would be interested in ❤ Trials With NO Existing Health Condition and is expecting Linear to contact themMy friend would be interested in ✚ Trials WITH an Existing Health Condition and is expecting Linear to contact them
Great Job! You can add more friends below! Just tick the add another friend button ☑️
I would like to add another friend
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Please confirm which statement is true:

My friend would be interested in ❤ Trials With NO Existing Health Condition and is expecting Linear to contact themMy friend would be interested in ✚ Trials WITH an Existing Health Condition and is expecting Linear to contact them
I would like to add another friend
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Please confirm which statement is true:

My friend would be interested in ❤ Trials With NO Existing Health Condition and is expecting Linear to contact themMy friend would be interested in ✚ Trials WITH an Existing Health Condition and is expecting Linear to contact them
I would like to add another friend
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Please confirm which statement is true:

My friend would be interested in ❤ Trials With NO Existing Health Condition and is expecting Linear to contact themMy friend would be interested in ✚ Trials WITH an Existing Health Condition and is expecting Linear to contact them
I would like to add another friend
Wow! You have so many friends! Their participation could lead to groundbreaking medical breakthroughs! Thank you!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: 0000000000.
Please confirm which statement is true:

My friend would be interested in ❤ Trials With NO Existing Health Condition and is expecting Linear to contact themMy friend would be interested in ✚ Trials WITH an Existing Health Condition and is expecting Linear to contact them
Should be Empty: