Registering an Organization on the Network

Adding an organization to 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 about the organization. Second, you will be asked to briefly indicate the organization's international child health activities and interests. This information is vital because it is the basis by which the Network is sorted and searched. Lastly, you will need to choose a password and username. Please safeguard this username and password because they will allow you to:

Organization Registration

Section 1 - Contact Information

Organization Name:
Contact Person:
Street Address:
City or Town:
State or Province:
Country:
Zip / Postal Code:
Email Address*:
(*email address is required)
Telephone:
Fax (if any):

Section 2 - Areas of interest, expertise or experience

Please choose the category(s) which best describe your organization's activities. Select all that apply. (To choose more than one option hold down the control key on your keyboard while clicking)


Please indicate in which countries you currently operate. Select all that apply. (To choose more than one option hold down the control key on your keyboard while clicking.)


Please enter a brief description of your organization here:


Section 3 - Choosing a password and username

To complete the registration process please choose a username and password. Save them 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, and please remember to invite others to join as well!