Haiti Health Network - Registration Question Title * Your name Question Title * Email Question Title * Contact numbers Question Title * Professional Title Question Title * License / Formal Medical Training Community Health Worker Nurse Nurse Practitioner Lab Technician Biomed Pharmacist Physician Surgeon None Other (please specify) Question Title * What type of registration are you completing? Individual - Register yourself as a Haiti Health Network Member Healthcare Supporting Organization or Educational Institution - Register yourself and your supporting organization or educational institution that supports healthcare in Haiti but does not provide direct patient care. Examples include but are not limited to; funding organizations, distribution organizations, maintenance organizations, building, transportation, etc. Healthcare Facility - Register your healthcare facility in Haiti that provides direct patient care services. Examples include but are not limited to; hospital, clinic, community health, birthing centre, vaccine clinic, prosthetics, lab, etc. Next
