Subscription for Rural Seeds

The Rural Seeds is an acronym for "Rural World Doctors in Training" made mainly by students and young doctors with the aim to be a world network to raise awareness and guidance in training for rural practice using the mentorship and knowledge available from WWPRP and its members. Further one of our main aims is to identify rural health care needs in different areas, countries and regions and try to understand what they could improve through local and global community.

This form aims to collect data from students and Young Doctors (and interested people) from all around the world so that we have a database of subscriptions to the RuralSeeds - World Rural Doctors in Training.

The participation and engagement on the group is totally free. Be aware that the data generated by this form could be used for scientific purposes. However any personal data for instance: e-mail address, identification, Name, address and date of birth will be not revealed. As you answer this form you agree to be added on the Rural Seeds Google Group.

Finally, you can drop in or out whenever you want and feel comfortable.

Email address *
Identification Data
These following questions will be used to identify who is engaging with Rural Seeds.
Complete Name *
Make sure that you write your complete name!
Your answer
Surname *
Your answer
Email *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Country *
Do you have any rural background that you consider? *
If yes, please tell a bit about your rural background..
Your answer
City, state (county or others) *
Your answer
Address
Your answer
Phone number
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service
Google Forms