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Further & Higher Education Name
Department
Address
Town
County AntrimArmaghDerry/LondonderryDownFermanaghTyrone
Postcode
Location for delivery of programmes if different from above
Lecturer Name
Email
Contact phone No.
Please note that a Cancer Focus NI officer will deliver a minimum of two and maximum of six 45 minute sessions to your place of education over the course of one day. One or both programmes can be repeated to different student groups as required. Please fill out ALL fields:
Lifestyle Essential programme:
You Only Live Once programme:
Please indicate the preferred start time for delivery of your first session
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If you selected 'other', please indicate your answer
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