SmokeCheck - Working towards smoke free
Aboriginal communities in NSW

Home
About SmokeCheck
Our programs
Smoking facts

0 1 2 1 6

Number of people
trained by SmokeCheck

Search the website:

You are here: Home / Our programs / Training / Schedule / Form - register interest in having a workshop

Programs at a glance
Health services
Training
Quit programs
News
Sharing
Contact us

Training

Outline
Schedule
Online training module

Register your interest for SmokeCheck training in 2012

Indigenous Smoking Cessation Training - register interest

Please fill out the following:

This form was not completed correctly. Please review the items in red.

* required fields

Title:

First Name: *

Surname: *

Position:

Organisation:

Type of Organisation: *

Local Health District

Aboriginal Community Controlled Health Service

Non-Government Organisation

Other

I am interested in attending a SmokeCheck workshop: *

for the first time

as a refresher

Are you of Aboriginal or Torres Strait Islander descent?

Yes

Both

Business contact details

Street Address/PO Box: *

Suburb/Town: *

State: *

Postcode: *

Mobile/Phone: *

Email: *

Smoking Status

SmokeCheck encourages the participation of all health practitioners, regardless of their personal smoking status.

To help us in our program support activities, can you please indicate:

I am a smoker/occasional smoker

I am not a smoker

I prefer not to say

How did you hear about the SmokeCheck Workshop?

manager/colleague

SmokeCheck website

SmokeCheck newsletter

Learning & Development website

word of mouth

previously attended a workshop

other website / mailing lists

local media

other

Authorised by: Head of SmokeCheck. Last updated: 15-Dec-2011

Contacts | Disclaimer | Privacy Statement

SmokeCheck - Working towards smoke freeAboriginal communities in NSW

Register your interest for SmokeCheck training in 2012

SmokeCheck - Working towards smoke free
Aboriginal communities in NSW