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* 1. Full Name

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* 2. Email Address

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* 3. GMC/NMC Number

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* 4. FRT Number

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* 5. Are you an FSRH member?

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* 6. Have you watched the SRH Essentials Webinar? (encouraged but not mandatory)

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* 7. Are you an existing facilitator for SRH Essentials for Primary Care?

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* 8. I understand that the copyrighted Essentials Contraception for Midwives training materials developed and provided by the FSRH can only be used for the purposes of delivering an approved FSRH, Essentials Contraception for Midwives training course. I confirm that the use of the materials for any other purpose is not approved by FSRH and will result in cancellation of my approved facilitator status.

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* 9. I have read and will abide by the FSRH Personal Beliefs Guidance

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