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Register to take part
If you wish to participate in your Regional Maternal and Perinatal Mortality and Morbidity Committee, please complete this form.
Once you have registered and your account is approved, you will be invited to participate in your region's online hub within three business days.
Title*
--Select--
Mr
Mrs
Miss
Ms
Mx
Master
Prof
Dr
Hon
None are applicable
First Name*
Last Name*
Business / Organisation Name*
Email*
Password*
Password strength requirements: minimum 16 characters, at least one uppercase letter, one lowercase letter, one number and one special character. Special characters include ! @ # $ % ^ & * .
Confirm Password*
Full Address
eg: 45 Evans Street, Balmain NSW 2041
Screen Name*
Show screen name in forum/mapping/commenting tools etc.
(Please check this box if you wish to display your screen name instead of your full name on your published comments and contributions.)
Gender*
Male
Female
Other
Agreement to receive communications, project updates and information from Safer Care Victoria
Please state your position title.*
Please select the region you wish to participate in.*
Region - Barwon South West
Region - Gippsland
Region - Grampians
Region - Hume 1
Region - Hume 2
Region - Loddon Mallee
What health service are you employed by?*
Albury-Wodonga Health
Ambulance Victoria
Bairnsdale Regional Health
Ballarat Health Service
Bass Coast Health Wonthaggi
Benalla Health
Bendigo Health Service
Castlemaine Health
Central Gippsland Healthcare Sale
Cobram
Cohuna District Health
Colac Area Health
East Grampians Health Service Ararat
Echuca Regional Health
Gippsland Southern Health Leongatha
Goulburn Valley Health
Kerang District Health
Kyabram District Health
Latrobe Regional Hospital
Lister House
Mansfield District Health
Maryborough District Health Service
Mildura Base Hospital
Northeast Health Wangaratta
Numurka District Health
Orbost
Portland District Health
South Gippsland Health Foster
South West Health Camperdown
South West Health Service Warrnambool
Swan Hill District Health
Terang Medical Health Service
University Hospital Geelong
West Gippsland Healthcare Group Warragul
West Wimmera Health Service Nhill
West Wimmera Health Service Rainbow
Western District Health Service Hamilton
Wimmera Health Group Horsham
Yarrawonga Health
Please select the position title most relevant to you.*
Position - Ambulance Rep
Position - Anaetheatist
Position - Director
Position - GP Obstetrician
Position - HMO
Position - Maternity Manager
Position - Midwife
Position - Midwifery Educator
Position - Obstetrician
Position - Paediatrician
Position - Quality
Position - Registrar
Position - Sonographer
Position - Special Care Nurse
Position - Student
Position - Other
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Find Latitude/Longitude of your location:
On your computer, please visit
Google Maps.
Enter your address in top left area
Please select and click on your location or Right click on the map marker.
If right click, Select what's here?
A Pop up appears at the bottom of the screen with more info.
You can see a Numeric number there. This is your location's : Latitude, Longitude.
Please click on the number and you will get these in top left text box.
Please copy these now and enter in the text box at our website.
Go to Google Maps
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