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Pasifika Health Leaders Breakfast Seminar Series: Launch
4.
Registration form
*
1.
Full name
(Required.)
*
2.
Email address
(Required.)
*
3.
Gender
(Required.)
Male
Female
Gender diverse
Specify
*
4.
What Pacific ethnicity do you identify with the most?
(Required.)
Samoan
Tongan
Cook Islands
Niuean
Tokelauan
Fijian
Tuvaluan
Other Pacific
5.
If you are a student, please confirm which university you attend.
The University of Auckland
The University of Otago
6.
Which year of study are you currently in?
*
7.
Please confirm your attendance online or in person at the following venues for the ‘Pasifika Health Leaders Breakfast Seminar':
(Required.)
Auckland Hospital
Northshore Hospital
Middlemore Hospital
Tauranga Hospital
Waikato Hospital
Wellington Hospital
Christchurch Hospital
Dunedin Hospital
Online
8.
Please note any dietary requirements:
*
9.
How did you hear about this Pasifika Medical Association event/seminar?
(Required.)
Through university network
Through hospital colleagues
On social media
Pasifika Medical Association website
Word of mouth
Other (please specify)
*
10.
Please join our mailing list for future Pasifika Medical Association news and events.
(Required.)
Yes
No
Current Progress,
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