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* 1. Name

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* 2. Email address
(Please fill this in to receive your money off voucher!)

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* 3. Where do you live?

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* 4. Where are you in your midwifery journey? 
(Tick all that apply)

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* 5. What help do you need to become a midwife?
(Tick all that apply)

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* 6. What are you most interested in on our website?
(Tick all that apply)

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* 7. What would stop you from using our book or e-course to help you?
(Tick all that apply)

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* 8. Would you be interested in joining us on a one-day workshop all about midwifery and getting onto a uni place?

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* 9. What would you pay for this?

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* 10. What would you most like the workshop to include?
(Tick all that apply)

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