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* 1. Name:

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* 2. Email :

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* 3. Organization

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* 4. Designation:

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* 5. Country:

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* 6. Office Address:

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* 7. Telephone No:

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* 8. Mobile 1:

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* 9. Mobile 2:

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* 10. Working Group Preference (Please select only 1 working group against each preference)

  Preference 1 (One Option Only) Preference 2 (One Option Only)
Principles and Over-arching goals (Human Security, Human Rights, Equity, Quality, Effective Systems
Universal Access, Universal Coverage, Priority Issues and Indicators
Accountability and Governance
Financing and aid effectiveness
Vital Statistics, data and information systems
Knowledge Management and Innovation

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* 11. GHS membership Status (Please choose one only)

  Please choose one
Full Member (Economic South as defined by the World Bank)
Associate Member (Characterized organization in the economic north as defined by the World Bank)
Non Member
For registration as a member of the Global Health South Alliance please visit

http://www.globalhealthsouth.org/index.php/southern-cs-database/join-the-alliance

For additional information, please contact communications@chestrad-ngo.org

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