Managing Workplace Stress – MGDHS

Please complete the form below to register your expression of interest for the Managing Workplace Stress program on 18 June 2015 at Flinders University Rural Clinical School, Mount Gambier.

This program is offered only to SA Health employees, the 'employee number' is proof of your employment.

First name:*
Last name:*
Preferred name:
Title:*
E-mail:*
SA Health Employee number:*
Gender:
Position title:*
Hospital:*
Department:*
Year:*

Postal information

Home address:*
Suburb:*
State:*
Postcode:*

Contact information

Mobile phone:*
Pager number:
Dietary requirements? Please specify:*
Do you have any disabilities that we should be aware of? Please specify:*
How did you hear about the program:*
Name of Supervisor:*

Emergency contact

Full name:*
Phone number:*
Word Verification: