Smart Cities & the Surveillance Apparatus - Children's Health Defense Africa Chapter

Sign Up

Name*

Email*

Name

This field is for validation purposes and should be left unchanged.

Submit Content

We would love to know and share what is going in in health freedom in Africa. This is a form for African regions to submit content like articles relevant to their region. This content can be originally written, or previously published, with a Creative Commons licence

Your full name(Required)

Your email(Required)

Your phone number (with prefix)(Required)

The article is written

By me

By someone I know

With a Creative Commons license

Type of content submission(Required)

Please advise: 1. What is the article about? 2. When was the article was written? 3. Is it referenced - do you have sources? Please list at the end of the article or link text to URLS

File(Required)

Max. file size: 2 GB.

Post Image

Accepted file types: jpg, jpeg, png, gif.FileTitleDescription

Upload relevant relevant images. These must be original images or photos, or Creative Commons licenced. Please provide captions

Name

This field is for validation purposes and should be left unchanged.

Volunteer Only

Name(Required)

First Last

Where are you located?(Required)

Address(Required)

Street Address City State ZIP Code

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

What is your time zone?(Required)

Total number of hours typically available to volunteer on a weekly basis.(Required)

Which days of the week are you typically available to volunteer?(Required)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are you a native speaker in any language besides English?(Required)

Yes

No

Please list those languages.(Required)

Are you a CHD member?(Required)

What is your occupation?

Are you a doctor or nurse?(Required)

Doctor - MD or DO

Nurse

Other

In what areas would you like to volunteer?(Required)

Do you have professional experience in any of the areas in which you would like to volunteer?(Required)

Yes

No

Please describe your professional experience.(Required)

Please include any certifications or licenses related to this experience.

Please tell us about any special talents that you could provide as a volunteer?

Our promise to you:
Your personal information will only be used by Children's Health Defense.

Thank you so much for supporting Children's Health Defense!