Shiriki Membership Form

Thank you for your interest in Shiriki, an informal community of people who work in global public digital health. We ask for some information to know who's in the community and what type of work you do; this helps inform our programming. We may share aggregated data beyond this community. We won't share your personal information.

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* 1. Are you joining Shiriki or updating your information?

Joining as a new member

Updating my information

I attended a webinar but prefer not to join at this time

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* 2. Name

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* 3. Primary Email

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* 4. Alternative Email

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* 5. Affiliation Organization name

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* 6. Organization Type

Country government

CDC/USG/Other USG agency

Implementing partner

Academic institution

Regional/Global agency

Company

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* 7. Source (how did you hear about Shiriki?)

Participated in I-LEAD/GEEKS

Invited to a webinar

Recommended by a colleague

From Shiriki materials

Other (please specify)

Shiriki Membership Form

Question Title

* 1. Are you joining Shiriki or updating your information?

Question Title

* 2. Name

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* 3. Primary Email

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* 4. Alternative Email

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* 5. Affiliation Organization name

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* 6. Organization Type

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* 7. Source (how did you hear about Shiriki?)

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* 8. Country