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* 1. Name

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* 2. Email

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* 3. Telephone

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* 4. Your SPA membership number

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* 5. Are you a NSW Health employee?

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* 6. If yes to Q5, what is your StaffLink number?

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* 7. Which LHDs can you assist in (see link for more detail) Metropolitan local health districts/speciality health networks?

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* 8. Which LHDs can you assist in (see link for more detail) Rural and regional NSW local health districts?

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* 9. When are you available – day and time?

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* 10. Any questions or comments?

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