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Joining the International Child Health Network

Joining the International Child Health Network is easy. The form below has 3 brief sections. In the first, you will be asked to enter some basic contact information. If you prefer, you can keep certain information (name, address, telephone) from being displayed in the public listing as long as you list a valid email address. Second, you will be asked to briefly indicate your particular areas of interest, expertise or experience in international health. This information is key because it forms the basis by which participants are sorted and searched within the Network. Finally, you will need to choose a password and username. You will probably want to safeguard this username and password because they will allow you to:

Network Registration

Section 1 - Contact Information

First Name:
Last Name:
Street Address:
City or Town:
State or Province:
Country:
Zip / Postal Code:
Email Address*:
(*email address required)
Telephone:
Fax (if any):
Would you like to keep the above information (except email) confidential?

No, this information may be posted    Yes, keep this confidential


Section 2 - Areas of interest, expertise or experience

Please choose the category(s) which best describe your health-related skills from among the following 5 lists. Select all that apply. (Hold down your Control Key to select more than one item.)

Doctor:

Medical Support:
Nurse:
Oral/Dental:
Other Medical Field:
Researcher:
Student:

Please indicate your areas of interest by clicking on the box next to the topic. Select all that apply. (Hold down your Control Key to select more than one item.)

Advocacy:

Education:
Organizational Activities:
Research:
Service:
Supplies and Equipment:
Visitor/Exchange:

If you offered to share personal experience/advice on working in another country, please indicate which country in particular from the following list. Select all that apply. (Hold down your Control Key to select more than one item.)

If you expressed interest in hosting a visiting colleague or person in training in your home, office, school or hospital, please describe briefly your offer:


Please indicate which languages you speak. Select all that apply. (Hold down your Control Key to select more than one item.) If you speak a language not on the list, please select "Other," and make a note of that language in the personal history box at the bottom of the page.

Please indicate languages into which you would be willing to translate materials. Select all that apply. (Hold down your Control Key to select more than one item.) If you speak a language not on the list, please select "Other," and make a note of that language in the personal history box at the bottom of the page.

Please indicate any countries in which you have personal contacts who might be able to assist others. (Hold down your Control key to select more than one country.)


Please enter a brief description of yourself here:



Please describe briefly the kind of research you are interested in collaborating in:


Section 3 - Choosing a password and username

You have almost completed the registration process. All that remains to do now is to choose a username and password. Make sure to write them down in a safe yet easily remembered location so that you can update or delete your record from the registry at a later date.
Username:
Password:
Confirm Password:

Please review all of the information you have entered. When you are certain that there are no errors, press the submit button below. If you leave some of the data fields blank, you may receive an error message. If so, you can simply go back, fill in the missing data, and resubmit.

  Thank You!