Name:
*
Organisation:
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Postal Address:
Email address:
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Tel:
Please select the location for the workshop you would like to attend:
Location:
-- Please Select Location --
Auckland Thursday 6 August
Wellington Thursday 30 July
Christchurch Wednesday 14 October
Dunedin Monday 16 November
Number of attendees:
Names of attendees:
I have read the terms and conditions set out in the
brochure
I would like to enroll
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1
2
3
4
5
6
7
People for the following course
Course:
Friday 3 July
Friday 26 November
Names of enrollees:
I have read the terms and conditions set out in the
brochure
Year complaint arose:
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Mental health service in which complaint arose:
Northland
Auckland
Coromandel
Waikato
Rotorua - Taupo
Bay of Plenty
Gisborne
Hawkes Bay
Taranaki
Wanganui - Manawatu
Wellington Area
Nelson
Marlborough
West Coast
Canterbury
Queenstown - Wanaka
Otago
Southland
General description of complaint (optional):
Please note, if appropriate I will forward details to the district inspector responsible for that region.
Your question:
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