REGISTRATION
Cultural Safety Education Events
5 April (Orange), 27 April (Dubbo) & 14 June (Bathurst) 2023

Thank you for registering for this education event.

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* Your details

Full Name

Primary workplace

Town

Preferred Email Address

Mobile Number

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* Profession:

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* I would like to attend the following session:

Orange (5 April 2023)

Dubbo (27 April 2023)

Bathurst (14 June 2023)

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* Do you have any special dietary requirements?

Yes (please provide details below)

Please list special dietary requirement(s):

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* Do you identify as Aboriginal or Torres Strait Islander?

Yes

Prefer not to say

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* By checking this box you submit your information to the Western NSW Primary Health Network (WNSW PHN), as the event organiser, who will use it to communicate with you regarding this event and their other services. You also consent to being photographed by WNSW PHN and our identified event partner TAFE NSW West. Any material may then be used for online, social media, marketing or promotional purposes. If you do not consent to the above, please email cpd@wnswphn.org.au prior to the event date - please mark email as 'Urgent' and state your request not to be photographed/recorded

I consent

I do not consent (please email cpd@wnswphn.org.au prior to the event)

Thank you for supporting this WNSW PHN education activity

Registrations will remain open until 8 days prior to the meeting date, unless capacity is reached beforehand.

We look forward to welcoming you to this event

Your assistance in sharing the event flyer with relevant colleagues and communication networks is appreciated.

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100% of survey complete.