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* 1. What is your name?

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* 2. What is your email?

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* 3. What is the best way to contact you by phone?

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* 4. What is your post code?

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* 5. What is your discipline?

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* 6. What clinical unit do you work with?  e.g. Emergency at Prince Charles Hospital

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* 7. Do you have any food allergies or dietary requirements?

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* 8. If you have food allergies / dietary requirements, please specify

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* 9. I agree to receive updates on the End of Life for Clinicians project

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* 10. I agree to receive updates on the QuoCCA project (education in paediatric palliative care)

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