CoP Registration Form

Required fields are marked with an asterisk (*).

Section 1: Applicant details

Full name *

Organisation/workplace name *

Organisation type *

• Queensland Health
• Queensland Ambulance Service
• Non-government organisation

Organisation postcode *

Professional role/discipline (e.g medical, nursing, allied health) *

Phone number

Email address *

In 100 words or less, briefly describe your role as an educator, including your key responsibilities and areas of focus *