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* 1. Full name

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* 2. Email address

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* 3. What would you hope to get out of the support group? Please tick all that apply

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* 4. If you are a professional and want to have an input to this group please give brief details below and someone will be in contact

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* 5. When would you prefer to meet virtually?

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* 6. Are you happy being in a (potentially) large group call 

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* 7. Is there any other information you would like to add?

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