HENI Membership form
This is an application form for membership to the Health Equity Network India (HENI). For any query in filling this form, please contact the HENI Coordinator at heni@iphindia.org. For more details on HENI, visit the website www.healthinequity.com
Email address *
First name *
Your answer
Last name *
Your answer
Name of HENI member who referred you *
Your answer
Age group *
Gender *
Organisation(s) *
Please enter NA if not affiliated to any organisation
Your answer
List areas of interest in health equity research *
Use only keywords. Avoid sentences. Separate keywords with commas
Your answer
How do you engage with health equity research? (multiple responses possible) *
Multiple responses possible
List any health or research networks you belong to (optional)
Your answer
I declare that I have read the HENI concept document and understand the role of a member in the network *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy