Enrollment Form

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Enrollment Form

Please fill in this form to enroll yourself with the "COVID-19 Action Group on AI and Radiology" and contribute to this pro bono public health research initiative. We trust in the information you provide and shall not publicly list your identity details anywhere until you agree to it.

Email *

Name *

Affiliation *

I am a *

Mobile Phone Number / WhatsApp number *

Registration Number (If you are a Physician)

LinkedIn / ResearchGate / GitHub profile / Webpage

How would you like to contribute, and do you wish to be contacted by the team for detailed discussions?

Do you wish to be publicly listed as a contributor *

Yes

A copy of your responses will be emailed to the address you provided.

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