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Healthcare Provider Volunteer Expression of Interest Form
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1.
What is your name?
(Required.)
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2.
What is your address?
(Required.)
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3.
What is your e-mail address?
(Required.)
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4.
What is your phone number?
(Required.)
5.
What is your profession?
6.
Please list any subjects you feel you are a subject matter expert.
Please find current volunteer opportunity postings and job descriptions
here
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7.
Please select the volunteer opportunities you would be interested in.
Networking Working Group (Professional Section)
Communication Working Group (Professional Section)
Recognition Working Group (Professional Section)
Evaluation and Quality Improvement Working Group (Professional Section)
Special Interest Groups (Professional Section)
The Essentials Working Group
Dissemination & Implementation Steering Committee
Dissemination & Implementation Website Working Group
Dissemination & Implementation Resource Updating Working Group
Webinar or Podcast Speaker
Clinical Practice Guidelines Author
Resource Updating
Professional Conference Planning Committee
Diabetes Frontline Forum
Media Spokesperson
Advocacy
Other (please specify)
8.
Please upload your resume.
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9.
Is there anything else we should know about you?
“Unless otherwise noted, Diabetes Canada will use the data collected for analytical purposes to determine what services we can provide to better understand and manage diabetes. Identifiable information will only be collected with your consent and unless otherwise notified will not be shared other than with Diabetes Canada or its affiliates who may complete data analysis on Diabetes Canada’s behalf."
“By providing your contact information you are permitting Diabetes Canada to contact you.”