Application for membership of Wiki Project Med Foundation
Members' Wikimedia usernames and country of residence will be public. Other information (real name, full address, email address, contact number, sex, age, conflict of interest, etc.) will be collected and stored by the Membership Secretary.

Per New York Not-For-Profit Corporation Law § 621, the list of current members' real names and addresses (only) may be viewed at our New York office by anyone (or their agent or attorney) who has been a member for at least six months immediately preceding their request to view. Your Wikimedia user name will not be revealed; neither will any other information - just name and address. If we receive such a request, we will email all members five days before viewing occurs, so they may resign from the foundation and have their name and address removed from the viewed list.

User name *
The name you use on Wikimedia projects such as Wikipedia.
Your answer
Check the box if you support our mission. *
Our mission is to make clear, reliable, comprehensive, up-to-date educational resources and information in the biomedical and related social sciences freely available to all people in the language of their choice.
Required
What is the main language you edit?
Your answer
Do you have a commitment or loyalty that conflicts with our mission? *
Such as receiving payment to positively represent a therapy. This will be kept private.
Your answer
Are you presently banned or blocked from contributing to any Wikimedia projects? *
This will be kept private.
Required
What is your address *
This can be viewed in our New York office by any current member whose membership is older than six months.
Your answer
What is your legal name? *
This can be viewed in our New York office by any current member whose membership is older than six months.
Your answer
Email address *
This will be kept private.
Your answer
Phone or Skype contact
This will be kept private.
Your answer
Education background, area of expertise.
This will be kept private
Your answer
Sex
This will be kept private.
Year of birth
This will be kept private.
Your answer
Is your Wikimedia account at least 3 months old with at least 100 edits in the last 12 months? *
If your answer to the last question was "No", describe your significant contributions to Wikimedia medical content or your involvement with Wikimedia outreach or with an organisation or activity whose aims align with ours.
Your answer
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