CHERI - The Children's Hospital Education Research Institute: Register details form

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CHERI, The Children’s Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145

Personal details			*Denotes mandatory fields
Name*
Company (if applicable)
Please contact me by	Post Email
Address*
Suburb*	State* Postcode*
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Phone	Fax Mobile
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I am a: (please choose)	Parent OR
	Professional	Teacher Occupational therapist Speech pathologist Psychologist	Medical - please specify Allied health - other Other - please specify
My interests are: (please choose at least one)	Attention Deficit Hyperactivity Disorder Velocardiofacial syndrome Neurofibromatosis type 1 Psychology Language Mental Health		Learning difficulties Behaviour Education (Special Education) Children Adolescents

Privacy policy - The Children’s Hospital Education Research Institute (CHERI), will use information it collects from you for the primary purpose for which it is collected and for such other secondary purposes that are related to the primary purpose of collection. Personal details that CHERI collects include your name, address, contact details, gender, occupation and areas of interest. CHERI will store and use your personal details to provide you with information on CHERI’s events and activities. Please notify us in writing if you do not wish to have your personal details stored. CHERI will not disclose your personal details to a third party without your permission. You are entitled to access all personal details held about you and to advise CHERI of any inaccuracy.

Suite 11, Level 2, Children's Hospital Medical Centre, Hainsworth St, Westmead NSW, 2145.
Telephone: + 61 (0)2 9845 0418 | Fax: + 61 (0)2 9845 0421 | Email: info@cheri.com.au Disclaimer

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