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* 1. Name

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* 3. Phone (optional)

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* 4. Organisation name

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* 6. Where is your organisation based?

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* 7. Are you interested in running the self advocacy training within your own community?

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* 8. How would you prefer to access training (tick all that apply?)

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* 9. Would you require funding to access the train the trainer course?

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* 10. Approximately how many service users would access the training once your organisation had received Train the Trainer training?

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* 12. Any additional comments?

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