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First Name

Surname

Email

Address 1

Town

Postcode

Telephone

PA

Please select one of the following:

I am a P.A. employed directly by the person I support

I pay an agency to supply my P.A's

I am considering employing a P.A.

I am self-employed as a P.A.

I am a P.A. supplied by an agency

I am considering becoming a PA

I employ P.A's directly

(please insert number)

Please select one of the following:

I receive Direct Payments

I receive Individual Budget payments

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