Global Medicine Network Registration (Organization)

Organizational Registration

Thank you for registering with the Global Medicine Network! Joining the Global Medicine Network is easy. The form below should take no more than 5 or 10 minutes to complete.

In the first section, you will enter basic contact information for your organization. In the second section, you will be asked to briefly indicate the organization's international health activities and interests.This will create your profile which you and other organizations in the network can use to match up common services and needs. Lastly, you will create a user name and password to log into the network as a registered member organization.

We thank you for your interest in the Global Medicine Network!

—The Massachusetts Medical Society Global Medicine Committee

Section 1: Contact Information
Required information is in red.

Organization Name
Primary Contact Name
Email
Website URL
Street/Postal Address
City/Town
State/Prov.
Zip/Postal Code
Country
Telephone
Fax

Top

Section 2: International Health Activities and Interests

Please choose the category or categories which best describe your organization's activities. (Hold Control or Command key and click to select multiple items.)

Activities:

Please indicate any countries in which you currently operate. (Hold Control or Command key and click to select multiple items):

Please enter a brief description of your organization here (3000 characters limit):

How can your orgnization help the Global Medicine Network?

	We can promote contacts among individuals and organizations in our home area/country.
	We can promote contacts among individuals and organizations in other areas/countries.
	We can recruit additional members to join the Network.
	We can provide service exchange opportunities to Network members.
	We can donate or distribute supplies, equipment, books, or journals.
	We will write or review grant proposals to fund international health projects, including the Global Medicine Network.
	We can identify funding sources or contribute financially to the GMN.

You have almost completed the registration process!

All that remains to do now is to choose a username and password. Save them so that you can update or delete your record from the registry at a later date.

Username: Same as your Email

Password

Confirm Password

Press the "submit" button below after reviewing your answers.

Thank you!

Top | GMN Introduction