Primary Care SIG Expression of Interest Form

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If you would like to express your interest at joining the Primary Care SIG, please complete this form.

First name *

Last name *

Email Address *

Secondary contact details

What are your areas of expertise? *

What is your nationality? *

What is your professional background? *

Pharmacy

Physician

Nursing

Community care

Dietitian

Physiotherapist

Social worker

Other:

Required

What is your personal, professional, and/or policy experience with disasters? *

Can we contact you directly via email about Primary Care SIG matters? *

Yes

Would you be interested in being a part of a WhatsApp Primary Care group in the future? [If you would like to, please provide your phone number in the other text box]

Yes

Other:

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