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Pasifika Health Leaders Webinar
'Shining Light on Public Health'
Wednesday, 6 July 2022 | 5pm-6pm NZT
20.
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 Island Maori
Niuean
Tokelauan
Fijian
Tuvaluan
I-Kiribati
Solomon Islander
Tahitian
Papua New Guinean
Rotuman
Maori
NZ European
Other European
Asian
African
Middle Eastern
Other Pacific
5.
Please state your profession/occupation and name of employer.
Occupation
Name of Employer
6.
If you are a student, please confirm which university you attend.
The University of Auckland
The University of Otago
Other (please specify)
7.
Please state the qualification you are enrolled in (e.g. Bachelor of Health Sciences, Certificate of Nursing etc)
8.
What is your current year of study?
*
9.
Please confirm your attendance online or in person at the following venues for the ‘Pasifika Health Power Webinar':
(Required.)
Auckland City Hospital
Waitakere Hospital
Middlemore Hospital
Tauranga Hospital
Waikato Hospital
Taranaki Hospital
Wellington Hospital
Christchurch Hospital
Whakatane Hospital
Dunedin Hospital
Online
Other
Other (please specify)
10.
Please note any dietary requirements:
*
11.
How did you hear about this Pasifika Medical Association event/seminar?
(Required.)
Through university network
Through PMA Notices
Through hospital colleagues
Through PMA members
On social media
Pasifika Medical Association website
Word of mouth
Other (please specify)
*
12.
Please add me as member of and mailing list for Pasifika Medical Association to receive the Webinar Zoom Link and notices.
(Note: You must be a PMA Member to attend the webinars)
(Required.)
Yes
No
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