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Global Health Program or Individual Member
The information on this form will be used to add you, as an individual network member, or you as a representative of your institution / global health program to the Global Health Pathology Network so that others in the Network can contact you.
Are you submitting this form as an
Institution/Global Health Program
Both institution and individual contact for that institution/global health program
Name of Individual with Affiliation or Name of Institution
Name of Global Health Program within Institution (if applicable)
Your expertise and/or Institution's Vision/Mission Statement
Additional contacts (if applicable)
General or Region(s) of work or interest to work (please select one or multiple as appropriate)
Reason for Interest in GHPN (please select)
I can provide pathology expertise
I am interested to receive pathology support
I am interested to fund Global Health Pathology work
A copy of your responses will be emailed to the address you provided.
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