Position Statement Working Group EOI

Midwifery Practice Review Face-to-Face Waitlist

Please complete the form below to be added to the MPR Waitlist or Express your Interest in a new location for a Face to Face event.
Contact Name:

First NameLast Name
Phone Number:
Format: 0000 000 000.
E-mail Address:
example@example.com
We are currently planning MPR events in the following locations. Would you be interested to attend a MPR event in any of the following locations?

Other
Please specify any other locations you would like us to attend for the face-to-face MPR events. Please note: We need a minimum of 8 and maximum of 10 participants for in-person events. Share with colleagues and encourage them to complete this waitlist form if they are interested.
What is your context of practice?
Please comment below if you answered 'Other' or have multiple contexts of practice.
How long have you been a midwife?
Are you an endorsed midwife?
Have you previously completed an MPR through ACM?
Please provide a brief description of your current and previous role / roles in midwifery (dot points welcome):
Are you a current ACM member?
Do you identify as First Nations Australian?
Do you identify as Culturally and Linguistically Diverse (other than First Nations)?
Optional - Please provide details to question above.
Where do you live? (state / territory)
Where do you live? (MM category)
Should be Empty:

Midwifery Practice Review Face-to-Face Waitlist