Health Down South

Register Interest

All fields NOT labeled "optional" are required.

GENERAL
Full Name:
Occupation:
e.g. consultant, Registrar, House Officer, Nurse, Physiotherapist, Radiographer, etc.
Specialty (Optional):
e.g. A&E, ITU, Mental Health, Oncology, Older People's Health, General Medicine, Urology, etc.

CONTACT DETAILS
Home Phone:
Mobile Phone:
Email:
Mailing Address (Optional):

REGISTRATION
At what stage is your registration with the relevant NZ Professional Body? (Optional)

FAMILY
Partners Name (Optional):
Partners Occupation (Optional):
Children and Ages (Optional):
Individual or family hobbies/interests (Optional):
e.g. skiing, windsurfing, wildlife, mountain biking, etc.

GENERAL
When do you plan to come to NZ?
Interest in information from
Additional Comments: (please include any areas of special interest (e.g sub speciality interest, teaching), additional info on registration, or requests for specific information, etc)

How did you find out about Healthdownsouth?
If Other, please state:

Attach CV (required):		Accepted file types are: Word (doc + docx) , Acrobat (pdf) and Rich Text (rtf)
Attach Cover Letter (optional):		Accepted file types are: Word (doc + docx) , Acrobat (pdf) and Rich Text (rtf)

Home | About Us | News and Events | Giant Lifestyle | Big Careers | Testimonials | Contacts + Links | Legal Statement

© 2010 Health Down South

Health Down South