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RHTS Site Booking Form
Student ID:
First name:
Surname:
Address:
Email Address:
Campus:
SELECT CAMPUS
Cradle Coast
Launceston
Hobart
Discipline:
SELECT DISCIPLINE
Nursing
Medicine
Pharmacy
Allied Health
Other
Current Study Year:
SELECT YEAR
1st
2nd
3rd
4th
5th
Rural Health Teaching Site:
SELECT SITE
Campbell Town
Dover
Flinders Island
George Town
King Island
Nubeena
Oatlands
Queenstown
Scottsdale
Smithton
St Helens
St Marys
Swansea
Date From:
Format: dd/mm/yyyy (i.e. 21/12/2009)
Date To:
Format: dd/mm/yyyy (i.e. 21/12/2009)
Authorised Publication of the
University Department of Rural Health
© University of Tasmania ABN 30 764 374 782
CRICOS Provider Code 00586B
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rural.health@utas.edu.au
Last Modified: 19-Oct-2009
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