Professional Practitioners - UM Therapies

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* 1. First Name

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* 2. Last Name

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* 3. Business Name (if applicable)

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* 4. Location: Where do you practice? Please give the main suburb, city and country

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* 5. Please select all the UM therapies you practice AND at the level of accreditation you currently hold:

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* 6. Email Contact (will not be displayed)

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* 7. Website (will be displayed)

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* 8. Please upload a low resolution photo for your profile (file size limit is 1MB)

GIF, JPEG, JPG, PNG file types only.
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Please include a short biography of yourself. If you would like support in writing your biography, please visit the UniMed Living Sydney website to see examples of the Sydney practitioners' biographiess for inspiration.

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* 9. Please provide a short biography on yourself (max 100 words)

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* 10. I give my permission for information on this form to be published on the EPA public website

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