1. Registration Form

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* 1. Full name

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* 2. Email address

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* 3. Gender

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* 4. What Pacific ethnicity do you identify with the most?

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* 5. Please state your profession/occupation and name of employer.

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* 6. If you are a student, please confirm which university you attend.

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* 7. What is your area of study?

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* 8. What is your current year of study?

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* 9. Please confirm your attendance online or in person at the following venues for the ‘Pasifika Health Power Webinar':

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* 10. Please note any dietary requirements:

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* 11. How did you hear about this Pasifika Medical Association event/seminar?

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* 12. Please add me as member of and mailing list for Pasifika Medical Association to receive the Webinar Zoom Link and notices. (Note: You must be a PMA Member to attend the webinars)

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