Healthcare Provider Volunteer Expression of Interest Form Question Title * 1. What is your name? Question Title * 2. What is your address? Question Title * 3. What is your e-mail address? Question Title * 4. What is your phone number? Question Title * 5. What is your profession? Question Title * 6. Please list any subjects you feel you are a subject matter expert. Please find current volunteer opportunity postings and job descriptions here. Question Title * 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) Question Title * 8. Please upload your resume. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload your resume. Question Title * 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.” Done