Webinar request form

Council Handbook Sensitive Choice

Webinar request form

Webinar request form

Organisation

Host organisation name

Contact person

Name

Position

Phone number

Email address

Please select your preferred workshop topics

Adult Asthma - What’s New

Little Lungs - A Paediatric Asthma Update

Take A Breath - Asthma/COPD Medications and Devices

Asthma and COPD - They Do Overlap

Asthma in Spring - Allergies and Thunderstorms

Please select the proposed dates on which you would like to host the webinars.

Session 1

Date / time

Date

Time

Platform used

Session 2

Date / time

Date

Time

Platform used

Session 3

Date / time

Date

Time

Platform used

Estimated attendance

Provide an estimate of how many attendees you are expecting.

Number of GPs

Number of nurses

Number of pharmacists

Number of physiotherapists

Other health professionals

Confirmation

On confirmation of workshop date(s), formal notification will be sent to your organisation via email.

Confirmation

Name

Date

Date