WONCA Polaris Membership Sign-up Form
Welcome to the WONCA Polaris community! Please take a few minutes to complete our membership survey. Thank you!
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Email *
Please provide us with your full name below. *
What is your gender? *
What are your pronouns? *
What is your age range? *
Which country are you from? *
What is your primary cell phone contact? (Include your area code please) *
What is your primary email address? *
Which country do you currently reside? *
What is your current role? *
How many years have you been in the above professional role? *
Tell us a little about your interests/passions in Family Medicine and/or other medical specialties. *
Tell us a little about your interests/passions/hobbies outside of medicine. *
What are ways WONCA Polaris can enhance your community experience with us? How can we serve better serve you? *
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