Request edit access
High Impact Medicine Network 
This form is to collect data for the High Impact Medicine Network .

1) If you are comfortable with people accessing the information provided fill out the relevant portions below. The information will be added to this google spreadsheet:

https://docs.google.com/spreadsheets/d/1NG79rBQrvLua8Xc--64h4aZrqwoX6-BhdTRsmnoSP_Y/edit#gid=0
 
2) If you want to stay up-to-date on the High Impact Medicine group and to network with other individuals, provide your email address. We anticipate infrequent newsletters. (note: your email will not be shared without your permission and will be kept private).

All the questions below are optional and if you want to edit/remove any responses you are free to do so, just email me (lau.hunter.s@gmail.com)
Sign in to Google to save your progress. Learn more
Your Name *
Email Address
Your email will not be shared without your permission and will be kept private
Would you like the information below added to the public spreadsheet?
Note: If you just prefer to join the network without providing additional details, you can feel free to leave the forms  below blank
Clear selection
Current Organization/Field
Your Role
City/country you currently live in
Please select your time zone according to the UTC standard (Ex UTC-04:00). *
What would you like help with?
What could you help people with?
e.g. career mentoring, discussions, niche skills, network
What are your plans to have an impact?
e.g. Earning to give, working in pandemic preparedness, working in bio-security, building the EA community etc. It's okay to put 'unsure' or 'undecided'. This information won't be revealed, but helps us to connect you with the right people.                                                      
Anything in particular you'd like to discuss?
e.g. Causes, careers (feel free to leave blank)
If you're happy for people to contact you via Facebook/twitter, add your profile here.
If you're happy for people to contact you via LinkedIn, add your profile here.
Anything else you want to add to the sheet?
How familiar are you with Effective Altruism?
This won't be on the sheet.
Relatively new/unfamiliar
Very familiar
Clear selection
If needed, would you be interested in helping to manage/organize this group?
Clear selection
Anything else you want to ask/tell us?
This won't be on the sheet.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report