REGISTRATION AOD Education and Information Session
| Face to face, Broken Hill | 19 March 2026 | 5.30 to 7.30pm

Thank you for registering to attend this education activity

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* 1. Your details

First Name *

Surname *

Primary workplace

Town *

Preferred Email Address *

Mobile Number *

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* 2. Profession

Other (please specify):

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* 3. Do you have any special dietary requirements?

Food allergy (please list details below)

Gluten free

N/A (virtual event)

Nil

Vegan

Vegetarian

Halal

Lactose free

Please list food allergies or any other special dietary requirements:

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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 be added to the WNSW PHN's mailing list

Yes

I am currently subscribed (already receive education event invitations and communication)

Media and communication consent

I agree to:

My information being used by the Western NSW Primary Health Network (WNSW PHN), as the event organiser, to communicate with me via relevant registration and distribution lists regarding this event and other services
My details (name, role and organisation) being shared on an Attendance Record with identified event partner(s)
Being filmed, photographed and/or recorded by the WNSW PHN and our identified event partner(s). Any images/recorded material may then be used by the WNSW PHN and identified partners for online, social media, public promotion (print and electronic form), marketing and reporting purposes

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* 6. I have read the above:

Yes, I consent

No, I do not consent (please email cpd@wnswphn.org.au requesting not to be photographed / recorded)

Thank you for supporting this

Western NSW Primary Health Network (WNSW PHN)

education activity

Registrations will remain open until 7 days prior to the meeting date, unless capacity is reached beforehand

Your assistance in sharing the event details with relevant colleagues and communication networks is appreciated

Please CLICK the teal box below to
CONFIRM YOUR REGISTRATION