1. Registration form

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* 1. Full name

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* 2. Email address

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* 3. Gender

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* 4. What Pacific ethnicity do you identify with the most?

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* 5. If you are a student, please confirm which university you attend.

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* 6. Which year of study are you currently in?

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* 7. Please confirm your attendance online or in person at the following venues for the ‘Pasifika Health Leaders Breakfast Seminar':

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* 8. Please note any dietary requirements:

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* 9. How did you hear about this Pasifika Medical Association event/seminar?

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* 10. Please join our mailing list for future Pasifika Medical Association news and events.

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