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.
* Required
Email address
*
Your email
Identification Data
These following questions will be used to identify who is engaging with Rural Seeds.
Complete Name
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Make sure that you write your complete name!
Your answer
Surname
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Your answer
Email
*
Your answer
Date of birth
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MM
/
DD
/
YYYY
Gender
*
Cis man
Cis woman
Trans man
Trans woman
Shemale / Travesti
Non-binary identity
Other:
Country
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Choose
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States (USA)
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Virgin Island
Do you have any rural background that you consider?
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Yes
No
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
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