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1. First Name (Required.)

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2. Last name (Required.)

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3. Email contact (Required.)

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4. Age (Required.)

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5. Gender (Required.)

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6. Country of work (Required.)

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7. Current Hospital/workplace (Required.)

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8. Current Position and qualifications (Required.)

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9. How many years postgraduate are you? (Required.)

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10. Are you currently studying a degree?
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11. How many years have you worked in emergency or your current practice? (Required.)

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12. Any previous toxicology experience? (Required.)

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13. How would a toxicology course fit into your current training/practice? (Required.)

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14. Any training outside current country of residence? (Required.)

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15. Any expectations of the toxicology course? (Required.)

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16. Describe current access to toxicology education and advice. e.g. any poisons information services or consulting medical staff (Required.)

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17. By registering with the course, I agree that non identifiable information from this registration and results from the course may be used for research purposes to improve the course. (Required.)

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