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GLOBALink Membership Application Form

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

Post Office Box
Zip Code
Country 
State / Area 
City 
Telephone 
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) 
First tobacco control Advocate (Email address) 
Second tobacco control Advocate (name, address, telephone) 
Second tobacco control Advocate (Email address) 
Third tobacco control Advocate (name, address, telephone) 
Third tobacco control Advocate (Email address) 
Background
Curriculum Vitae ( )
Degrees in public health / tobacco control
Describe your activities in tobacco-control 
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