Request to join

Hello!

Welcome to the Health Equity Network sign up request form. Here, we're going to gather information about your work and interests in health equity. After this stage the next step will be an email from us inviting you to activate your account and set up a user profile. The information you provide below on your interests in health equity will be carried over onto the user profile for you. You can edit the information at that point if you wish.

* Required fields are marked with an asterisk

Prefix Firstname

First name *

Last name *

Primary email *

What sector do you work in? *

Provide information about your current area of health equity work or ongoing project . What do you want to collaborate on? *

Health Equity Interest Topics *

Keep this blank

I give consent to The Health Equity Network to use this information to build a profile when my request is approved. *