Find a MAT member campaign
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1
. Please provide contact information
Please provide contact information
Full Name:
Address 1:
Address 2:
Region/District:
State/Province:
ZIP/Postal Code:
Country:
Email Address:
Mobile Phone Number:
2
. Please list the Name of the Facility/Organization your working for or Studying!
Please list the Name of the Facility/Organization your working for or Studying!
3
. What is your internship status?{Applicable to those Yet to be employed}
What is your internship status?{Applicable to those Yet to be employed}
Not yet stated
Still doing Internship
Completed internship
4
. Please list your Internship Hospital/center. {For those who filled Q 3. above}
Please list your Internship Hospital/center. {For those who filled Q 3. above}
5
. Please List your Qualifications in the boxes below.{Includes postgraduate/Other course/qualification your pursuing}
Please List your Qualifications in the boxes below.{Includes postgraduate/Other course/qualification your pursuing}
I
II
III
IV
6
. Type of employment?
Type of employment?
Government
Private
DDH
NGO
Self employed
Not yet employed
7
. Have you ever been registered with MAT?
Have you ever been registered with MAT?
Yes
No
I Don't Remember
8
. What is the primary nature of your work?{Select all that applies}
What is the primary nature of your work?{Select all that applies}
Clinician
Lecturer
Research scientist
Administrative
Interprenuer
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