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Membership form - Africa Brain Health Network
Hello there. We are pleased that you are interested in joining the Africa Brain Health Network. Please take a few minutes to tell us a little bit about yourself.
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Email
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Your email
Hello, what's your name?
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Your answer
Which Country and City do you live and work
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Your answer
What's your profession?
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Your answer
What are some of the particular interests in your work?
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Your answer
What is your vision for Brain Health in Africa?
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Your answer
Are you working on a project that you are keen to collaborate with members of ABHN? Please tell us about it.
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Your answer
Would you like to join our WhatsApp group?
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No
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If you answered yes above, please share your contact below. (Include country code)
Your answer
And, would you like for your profile to displayed on our website?
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No
Other:
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If you answered yes to the above, please add your bio here.
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Your answer
Thank you for taking time to respond to our membership form. We will be in touch with you in the next few days. Do you have any questions or comments?
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Send me a copy of my responses.
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