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* 1. First Name

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* 2. Surname

Please refer to the Terms and Conditions under the Email for Attendee section. 

Please do not provide common or shared email addresses (e.g. admin@organisation.org.au OR staff@organisation.org.au)

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* 3. Email address

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* 4. Phone Number

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* 5. Stakeholder type

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* 6. Health Profession

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* 7. If you selected "Other" as Health Professions, please fill out your profession 

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* 8. Place of Practice: Organisation

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* 9. Place of Practice: Suburb and Postcode

Is your PRIMARY place of practice (i.e., where you practice most often) located in the WNSWPHN catchment? Each PHN is delivering IAR-DST training to their local area catchment. Please click here to confirm your place of practice is located in the WNSWPHN catchment before registering. If your place of practice is NOT in our catchment, please contact your local PHN to enquire about IAR-DST Training.   

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* 10. Confirm your PRIMARY place of practice is located in WNSWPHN catchment

If you answered 'No' above, please consider attending the National Training, or contact your local PHN for training in your area. 
Please refer to Terms and Conditions section

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* 11. Please provide your RACGP / ACRRM membership number.

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* 12. Agree to Terms and Conditions

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* 13. How did you hear about this training?

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