ECHO Registration
I have had the opportunity to consider the above information, ask questions and these have been answered satisfactorily
*
Yes
I consent to Hospice Isle of Man managing my personal data in connection with Project ECHO
*
Yes
I consent to the processing of my Personal Data for Project ECHO administration and videography purposes
*
Yes
I consent to the public use of videographic recorded sessions containing my image for both internal and external use
*
Yes
I understand that my participation in Project ECHO is entirely voluntary and that I am free to withdraw my consent at any time, without providing a reason or explanation
*
Yes
I confirm that any materials I access from the ECHO data repository as granted by Hospice IOM will be treated in accordance with the common law Duty of Confidentiality
*
Yes
Echo Network
Please Select
Nursing Homes - IOM End of Life Care
Pharmacy
Link Nurse ECHO Network
Full name
*
Ms
Miss
Mrs
Mr
Dr
Title
First Name
Last Name
Email Address
*
Confirmation Email
example@example.com
Organisation
*
Job Title
*
Signature
Submit
Submit
Should be Empty: