TBpeople membership application form

Questions with an asterisk are mandatory
All data provided in the application is kept confidential

Question Title

* 1. I would like to become a member of TBpeople Network. Hereby I confirm that:

I have or had tuberculosis in the past

I haven't had tuberculosis, but my close ones -- friends or relatives -- have/had tuberculosis

I accept the vision, mission, and objectives of TBpeople

I accept terms of membership as described in the TBpeople Membership Regulations

PERSONAL INFORMATION

Question Title

* 2. First name

Question Title

* 3. Surname

Question Title

* 4. Middle name

Question Title

* 5. Gender

Question Title

* 6. Date of birth

Day/month/year

Date

Question Title

* 7. Country of residence

Question Title

* 8. Town

Question Title

* 9. Valid email address (it has to be your own personal email address, not belonging to another person or an organization)

Question Title

* 10. Contact telephone number

MOTIVATION

Question Title

* 11. Please describe briefly why you are interested in becoming a member of TBpeople. If you are applying for associate membership, please write who of your close ones had TB and how it affected your life.

Note: motivation does not affect the decision to whether or not accept you as member of TBpeople. It is important to us as it gives us the understanding of why you are interested in joining TBpeople.

Important: TBpeople is not just an organization, it is a community. That is why we ask our new members to introduce themselves in TBpeople mailing list.