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Thank you for your interest in joining OzHelp’s Clinical Advisory Committee. Please complete this form to support your expression of interest in serving on the Committee.

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* 1. Title

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* 2. Full Name

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* 3. Email Address

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* 4. Please provide details of your interest and demonstrated experience in mental health and suicide prevention.

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* 5. Please provide details of your expertise and qualifications that are specific to mental health.

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* 6. Please provide a brief description of your reason/s for wishing to join OzHelp’s Clinical Advisory Committee

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* 7. Please provide the names and contact details for two referees.

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