YP-CDN UG Membership Registration form for 2018
This is a membership registration form for Young Professionals Chronic Disease Network Uganda. A registration fee is currently not required. A notification will be sent to your email within 3 working days.
Email address *
Last Name/Surname *
First Name *
Email address *
Date of Birth
MM
/
DD
Gender
Clear selection
Which town are you based in?
Clear selection
Which is your field of focus/expertise? *
What are your main areas of interest? Check only 3 areas. *
Required
What are some of your additional skills that you can help YP-CDN Ug with?
Tick all that apply
Which YP-CDN Ug programmatic areas do you want to volunteer with?
In what capacity do you want to volunteer for YP-CDN Ug?
Describe any area you will be comfortable working in.
How much time can you volunteer for the chapter? (Kindly be as detailed as possible)
Clear selection
If you have volunteered before, please give details of where you have volunteered, for how long and describe your volunteer role.
Why do you want to Join YPCDN? *
Institution Affiliated/Employer/School.
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