Joining the International HPH Network?

Please take a few moments to tell us why, so we can improve in the future. Please indicate your reasons and expectations related to joining HPH. If you wish, you can freely select only the fields that apply to your specific situation and your specific expectations.

* 1. Member Hospital / Health Service name:

* 2. Member Hospital / Health Service Coordinator:

* 3. National / Regional Network name (if applicable):

* 4. Date of application (Letter of Intent):

* 5. Signature and date:

* 6. Primary reason for joining HPH is:

* 7. Expectations are:

* 8. Found out about HPH from:

* 9. Further comments: