EXIT

1. REGISTRATION FORM

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* 1. Full name

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* 2. Email address (*required)

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* 3. Gender

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* 4. Please specify your current occupation and place of work.

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* 5. What Pacific ethnicity do you identify with the most?

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* 6. If you are a student, please confirm which university you attend.

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* 7. Please specify your area of study and current year of study.

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* 8. Please confirm your attendance online or in person at the following venues for the ‘Pasifika Health Leaders Webinar':

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* 9. Please note any dietary requirements:

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* 10. How did you hear about this Pasifika Medical Association event/seminar?

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* 11. Please join our Pasifika Medical Association membership network for free to get more Pacific health updates, news and events.

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