CESPHN Pharmacist Health Professionals Network
Pharmacists
working in the Central and Eastern Sydney PHN, can complete this form to register to our Health Professional Network, allowing you to register
free
for our immunisation education events and many other
CPD education events
.
Pharmacist details
Salutation
Please select...
Mrs
Ms
Miss
Mr
Preferred Name
First Name
Middle Name
Last Name
Gender
Please select...
Female
Male
Non-binary
Different identity
Prefer not to say
Different Identity
Job Title (if different to Pharmacist)
AHPRA Registration Number
Work number (work phone)
Mobile number (personal number)
Work Email
Personal Email
Primary employment - Name of pharmacy where you are currently employed
Secondary employment (if applicable) - Other pharmacy/pharmacies where you are currently employed
Additional Qualifications
Please select any additional qualifications you hold?
Aged care on-site pharmacist (ACOP)
Authorised immuniser
Residential medication management review (RMMR)
Home medicines review (HMR)
Other
None
Other: