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Password
My Profile
Registration Details
The following details are required for online registration purposes.
* required field
Name *
(This should be the name you wish to have on your certificate)
Alias
(This name is used in online group work to retain anonymity of participants)
Email *
(This will be used as your User ID and the primary notification method)
Password *
Phone Number
Mobile Number
Fax Number
Physical Address
Postal Address
Country
Date of Birth
(dd/mm/yyy)
Gender
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Male
Female
Ethnicity
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Maori
Pakeha
Pacific Island
Asian
European
Other
Highest Qualitifcation
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None
Secondary School
Graduate
Post Graduate
Masters
Doctorate
Are you currently studying?
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Yes
No
Company/Institution Name
Position
Department
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ED
Rural Hospital
Mental Health
Kaupapa Māori Mental Health
Māori Health
Primary Health
Designation
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Consumer Advisor
Cultural Advisor
Kaumātua
Administration
Social Worker
Doctor
Nurse
Other
Senior Management Contact
Mentor
Coure Type (Full/Half)
Where regular access will occur