Share Your Story (World Field Epidemiology Day)

Question Title

* 1. Full name:

Question Title

* 2. Job title:

Question Title

* 3. Institution (Employer)

Question Title

* 4. Country

Question Title

* 5. Are you a trainee or graduate of FETP, FELTP, EIS, EPIET, or similar program?

Yes

Question Title

* 6. If yes, please provide the name of your program and your year of graduation (actual or expected).

Question Title

* 7. Share a story about your work in field epidemiology that is meaningful to you. This story could illustrate a moment that made you proud, a moment that demonstrates the importance of field epidemiology, or something else that you would like others to know.

Stories may be submitted in any language.

Question Title

* 8. Please upload a photo of yourself.

Allowable file types: PNG, JPG, JPEG, GIF (file size limit: 16MB)

PNG, JPG, JPEG, GIF file types only.

Choose File

Optional: Video Stories

If you prefer to share your story as a video, please email your video to secretariat@tephinet.org with the subject line, "WFED Video Story." Write "I will submit a video story" in response to question #7 above.

Videos should be no longer than 2 minutes. Allowable file types are MP4, AVI, MOV, and WMV.

Question Title

* 9. Do you authorize TEPHINET, as the organizer of World Field Epidemiology Day, to share the information you have submitted on this form in its communications materials as it sees fit?

I allow TEPHINET to use this information in its communications materials.

I do not allow TEPHINET to use this information.