YP-CDN UG Membership Registration form APRIL 2017
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.
Last Name/Surname
Your answer
First Name
Your answer
Email address
Your answer
Date of Birth
MM
/
DD
Gender
Which town are you based in?
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.
Your answer
How much time can you volunteer for the period from April- Oct 2017? (Kindly be as detailed as possible)
If you have volunteered before, please give details of where you have volunteered, for how long and describe your volunteer role.
Your answer
Why do you want to Join YPCDN?
Your answer
Institution Affiliated/Employer/School.
Your answer
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