Setup

* Username

*

Title

* First Name

*

* Last Name

*

* Email Address

*

* Password

*

Strength: Very Weak

Phone Number

* Please indicate whether you agree with the aim of Scottish Palestinian Health Partnership: "to collaborate in support of the development of health and healthcare in Palestine"

I agree

I disagree

* Your Occupation: please describe profession/ specialty/ areas of study or research.

*

* Please indicate whether you are currently -

Working

Not working

Studying

Retired

* Address of your current place of work or study (most recent, if retired or not working)

*

* Do you have experience of working in Palestine?

Yes

No

If "yes", please describe briefly

Language spoken

This is not required information but a record of members who speak Arabic is likely to be helpful

* Please confirm that you are aged 18 years or over

Yes

No

SPHP will keep your personal data confidential and will not share this with any third party. SPHP will send you their newsletter and information about relevant events. You can withdrawn your consent at any stage by writing to info@scotpalhp.org

* Please indicate whether you consent to your personal data being used in this way.

I consent

I do not consent

* Date of application

*

Setup

Signup Page