DialoguePH Membership Registration

Please fill in the form below. Mandatory fields are marked with an asterisk.

Account Information
Email Address:* This will be your login username
Password:*  
Confirm Password:*  
Profile Information
First Name:*
Last Name:*
City:*
Province:*
Country:*
Please indicate your role:
  • Medical Officer of Health
  • Director
  • Manager
  • Front line Practitioner
  • Other, please indicate:
Please indicate your discipline/training (required):*
  • Physician
  • Health Inspector
  • Public health nurse/RN
  • Dietitian
  • Health promoter
  • Epidemiologist
  • Information Specialist/Librarian
  • Dentist/Dental hygienist
  • Other
Content area of interest/expertise: Please check all that apply.
Select All / Unselect All
  • :
Knowledge Translation and Exchange
  • One of my professional responsibilities is to share new evidence with my colleagues.
Publications
NCCMT connects with our audience in several ways. Choose the communications you are interested in:
Which email format do you prefer to receive?
Privacy Options
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Privacy statement

NCCMT respects your privacy. Your contact information will not be shared with external parties. Your name, e-mail address, content area of interest, and province will be visible only to other DialoguePH members who have also agreed to share their information.
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Would you like to display an alias or your name when posting in the discussion forum?
  • :

If after you have registered with DialoguePH, you do not receive any updates, newsletters, e-bulletins, etc., please call 905-525-9140 ext. 20451 and we will work with you to address the situation.

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