WAHO Diaspora Health Specialist Registration Form

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Title & Name *

Medical Specialty *

Country of Practice

Years of field experience

Phone Number 1 *

Phone Number 2

Country of Origin

Happy to receive Allowance only (A) / Wants to be Paid Fully (F)

Allowance only (A)

Wants to be Paid Fully (F)

Clear selection

Area of Interest within ECOWAS Country Health Service Needs - 1

Area of Interest - 2

COMMENTS, e.g. other contact details

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Submit

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