Registration Form | Hepatitis C for A&TSIHW/HPs Question Title * 1. Which training session are you registering for? National Online - Nov 27/Dec 4 2020 NT/WA Online - June 04, June 11 2021 NSW/ACT/VIC/TAS Online - July 15, July 22 2021 QLD/SA Online - July 16, July 23 2021 National Online - November 12 2021 Question Title * 2. First Name Question Title * 3. Last Name Question Title * 4. Organisation name Question Title * 5. Which of the following describes your main service setting? Aboriginal Community Controlled Health Organisation Aboriginal Medical Service Other (please write) Question Title * 6. City Question Title * 7. State/territory QLD NSW ACT VIC TAS NT SA WA Question Title * 8. Post code Question Title * 9. Mobile phone or best contact number Question Title * 10. Email address Question Title * 11. What would you describe as your main profession? Aboriginal and Torres Strait Islander Health Worker/Health Practitioner Aboriginal and Torres Strait Islander Community Worker Health Promotion/Educationalist Nurse Practitioner Midwife Practice Nurse Allied Health Professional General Practitioner Nursing – other Social Worker Question Title * 12. What is your position title? Question Title * 13. Do you identify as Aboriginal and/or Torres Strait Islander? Yes, Aboriginal Yes, Torres Strait Islander Yes, Aboriginal and Torres Strait Islander No Question Title * 14. Would you consent to being approached to take part in a small group discussion after the courseto assist us in improving the course? (Compensation of $100 will be provided. Further details will be provided closer to the date of the course) Yes No Question Title * 15. Do you have access to Zoom? Yes No Done