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GLOBALink Membership Application Form

Personal details
Gender Mandatory field
Title Mandatory field
First name Mandatory field
Middle name
Last name Mandatory field
Email address Mandatory field
Birthday Mandatory field
MSN
Skype
In tobacco-control since (year)
Photo (JPG only)
Organisation
Name of the organisation Mandatory field
Website
Position
Department
Address
Street, floor, suite Mandatory field

Post Office Box
Zip Code
Country Mandatory field
State / Area Mandatory field
City Mandatory field
Telephone Mandatory field
Direct telephone
Mobile telephone
Fax
Recommandations
To become Member of GLOBALink, you need to be identified as a Tobacco-Control Professional.
In order to trigger the application process, please list three known advocates who could recommend your Membership to the network (GLOBALink Members would be a plus).
Please give Full Name, Organization, Address, Tel, Fax and email.
First tobacco control Advocate (name, address, telephone) Mandatory field
First tobacco control Advocate (Email address) Mandatory field
Second tobacco control Advocate (name, address, telephone) Mandatory field
Second tobacco control Advocate (Email address) Mandatory field
Third tobacco control Advocate (name, address, telephone) Mandatory field
Third tobacco control Advocate (Email address) Mandatory field
Background
Curriculum Vitae ( )
Degrees in public health / tobacco control
Describe your activities in tobacco-control Mandatory field
Recent publications
Where did you hear about GLOBALink ?
Regular bulletins
GLOBALink Today
Medical Journal Update
NIMI (English)
Submission
I agree to the terms & conditions of GLOBALink, and I hereby certify that I am in no way affiliated with the tobacco industry, either directly or indirectly, and furthermore certify that I do not envisage any future affiliation with the tobacco industry.
TreaTobacco
LOCALink
Tobacco Victims
UICC Website
Tobacco Control Online