MND Special Interest Group (SIG) registration form

Membership of MND SIG is free and open to all health and community care professionals with an interest in motor neurone disease.

*Required

First name

Last name

Discipline

Comments

Organisation

Position title

Organisation address 1

Organisation address 2

Organisation suburb/town

Organisation state/terr

Organisation postcode

Country

Phone (w) include area code

Phone (mob)

I give permission for my name and contact details to be provided to other SIG members.

Yes

I have received a SIG Starter Pack.

Yes

Please send me a SIG Starter Pack relevant to my discipline (NSW and ACT only).

Yes

I can assist with

Contribution of articles or current topics

Review of articles or current topics

Speaking at MND NSW education programs for people with MND/family/carers

Tick the box

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