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

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* Personal Information 

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* Please specify your professional role

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* 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:

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* Please list the names and contact emails of known attendees from your team:

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