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 Expression of Interest (EOI) Form

This form is for individuals who wish to express their initial interest in joining the Indigenous PH Advisory Council. It is a brief, low-barrier way to indicate your potential candidacy.

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Section 1: Contact Information
First Name: *
Last Name: *
Preferred Pronouns (Optional): *
Email Address: *
Phone Number: *
City/Town: *
Province/Territory: *
Section 2: Indigenous Self-Identification
Do you self-identify as Indigenous (First Nations, Métis, or Inuit)? *
If Yes, please specify (e.g., First Nations, Métis, Inuit, specific Nation/Community, if comfortable sharing):
Section 3: Connection to Pulmonary Hypertension (PH)
Please briefly describe your connection to pulmonary hypertension (e.g., patient, caregiver, healthcare provider, advocate, community member impacted by PH). (Max 100 words) *
Section 4: Statement of Interest
Why are you interested in joining the Indigenous PH Advisory Council? (Max 150 words) *
Section 5: Consent
By submitting this Expression of Interest, I confirm that the information provided is accurate to the best of my knowledge and I consent to PHA Canada using this information to assess my suitability for the Indigenous PH Advisory Council. *
Required
Date of Submission: *
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This form was created inside of PULMONARY HYPERTENSION ASSOCIATION OF CANADA.

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