CHP Membership Form

This is the intake form for new members to the Centre for Health Policy.

Level of Membership

Member

Members have been or are currently active in the Centre’s work and agree to be called upon to contribute to initiatives of interest.

Affiliate

Affiliate members self-identify as working in the field of health and social policy and have an interest in engaging with the Centre.

Community Partner

Community partners include organizations, advocacy groups, governments, and individuals with lived experience or expertise in health and social policy.

Name (First and Last)

Degree(s)

Role (i.e. Associate Prof, Project Lead, MSc Student)

Organization (i.e. UCalgary, The Alex, ViVo)

Unit/Department (i.e. Community Health Sciences, Community/Partnership Engagement)

Your Headshot

Choose file

One file only.
10 MB limit.
Allowed types: gif, jpg, png.

Email (If you are joining on behalf of a group/organization, please input the group's email)

Policy Area(s) of Focus

May we contact you? (For the purposes of partnering with other faculty members and organizations working in the same area(s) of interest)

Yes

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.