REGISTRATION | Spirometry Training Course
Walgett | 9 February 2023 or
Bourke | 11 February 2023
(full-day workshop)

Please complete the following form to register for your preferred workshop

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* 1. Participant details

Name

Practice/AMS/ACCHO/Organisation

Town where you work

Preferred Mobile No.

Preferred Email Address

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* 2. What is your role?

GP Registrar

Nurse (working in general practice)

Nurse (working outside general practice)

Other (please specify your role):

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* 3. Do you have any special dietary requirements?

Yes - please list your special dietary requirements below:

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* 4. Do you identify as Aboriginal or Torres Strait Islander?

Yes

Prefer not to say

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* 5. I would like to register for the following workshop (please note the maximum number of participants is 15/workshop and a minimum of 10 participants/workshop is required to go ahead with each workshop - if this threshold is not met, the workshops may need to be combined)

Walgett Wait List (Thursday, 9 February 2023)
This workshop is currently FULL. Please complete your registration and then call Erica on 0428311887 to be placed on the wait list (you will be notified if a cancellation arises)

Bourke (Saturday, 11 February 2023)

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* 6. By checking this box you submit your information to the Western NSW PHN and the National Asthma Council (NAC), as the event organisers, who will use it to communicate with you regarding this event and their other services. You also consent to being photographed by WNSW PHN and on behalf of our identified event partner. Any photographic material may then be used for online, social media, marketing or promotional purposes. If you do not consent to your image(s) being shared, please email cpd@wnswphn.org.au immediately.

I agree

Thank you for supporting this WNSW PHN & National Asthma Council Australia partnership education activity

Your assistance in promoting this workshop to relevant local colleagues including GPs, Registrars and Nurses is appreciated.
Registrations will remain open until 8 days prior to each workshop, unless capacity is reached beforehand.

We look forward to welcoming you to this training

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100% of survey complete.