Membership Sign Up

1
Name
First Name
Last Name
2
Job Title
3
Department
4
Hospital/Institution
5
Email
example@example.com
6
Phone Number
7
Area of Research Interest
8
Do you have any dedicated research time in your current job plan?
YESNO
9
If yes, what percentage?
10
By submitting this form I agree to my personal data being held by GAPRUKI and to being used to be contacted by GAPRUKI about paediatric research issues and opportunities using the contact details above.
GAPRUKI will not share any personal details with outside parties without specific consent from members.
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