Expression of interest - Virtual ECHO Immersion Training Primary contact and team information When you and your team are ready to become an ECHO Replication Partner, please complete this form to schedule your team's attendance at Virtual ECHO Immersion Training and associated Partner Liaison meetings.If you have any questions regarding the process of becoming an ECHO Replication Partner through CHQ's Project ECHO Superhub, please visit our website or email ECHO.CHQ@health.qld.gov.au OK Question Title * Personal Information Full Name Organisation Postal Code Country Email Address Mobile Number OK Question Title * Profession Medical Allied Health Nursing Education Administration Human Service Professional Other OK Question Title * Please specify your professional role OK Question Title * Anticipated ECHO team role Program lead Content expert Network coordinator IT coordinator Other OK Question Title * How many members of your team do you anticipate will attend Immersion? Remember you need to send at least 3 team members, preferably including Program Lead, a content expert who could fill the role of Facilitator, and Network Coordinator: OK Question Title * Please list the names and contact emails of known attendees from your team: OK NEXT