Expression of interest: PERMA

Please complete the form below to register your expression of interest for PERMA training on Wednesday 14 November 2018. This program is offered to all 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:

Hospital/DOH:*

Department:*

Home address:*

Contact information

Mobile phone:*

Dietary requirements? Please specify:*

Do you have any disabilities that we should be aware of? Please specify:*

How did you hear about the program:*

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