Members Online Registration Form


General and Contact Information
* First Name
Middle Name
* Last Name
* Title
Gender
Date of Birth
Address for correspondence
Street Address
City
Country
Postal Code
Telephone Number
 
Fax Number
* Email Address

Nationality

* Country of Residence:
   In which you currently work



Member Profile
Current position title
Areas of interest:  (Please check all that apply)
(if others please specify)      
Academic Level:
With which type of organization is your primary affiliation?
Organizational Name (in full)
Street Address
City
Country
Postal Code
Telephone Number
Fax Number
Email Address
Website

Highest Degree / Most Advanced Degree (qualification)
Academic field in which you completed your degree
Institute from which you completed your degree
Full Name
Street Address
City
Country
Postal Code
Telephone Number
Fax Number
Email Address
Website


 
* Information accessed on the diabetes network database.

Information marked in asterisk is the only one that will be available online as part of the diabetes stakeholders network.

 

 

TERMS OF USE :

By submitting this application, I agree to the collection, use and processing of the personal information I provide to this membership application for the purposes of organization administration, and inclusion of my contact information(only those marked in asterisk *) in a members' directory that will be available for other members in the diabetes network. By submitting my personal information, I also agree that my information may be accessed and used by the project's administrators, specialists and coordinators.

I agree to notify cssp@bibalex.org of any change to my personal information, including making any request to delete or correct the information I submitted, so that it is accurate and current. I understand that the majority of the data requested in this application is necessary for administrative and planning purposes, and that the failure to provide this information may prevent the proper processing of my application or the inclusion of my contact information in the members’ directory. .

 

Membership Benefits

As a member of the Diabetes Supercourse for the MENA Region project, you will receive newsletters about upcoming conferences and activities concerning diabetes in the MENA Region, and updates including new lectures being posted on the diabetes supercourse website .It will also allow you to share with us your best papers and projects related to diabetes as a PowerPoint presentation online on our website.

Author Acknowledgment

As a submitting author, you acknowledge that your submission, including slides, will be posted on the Supercourse website and will be freely accessible for use as shareware to be used and shared by others without restriction.

Author Representation

By the submission of your lecture and slides to the Supercourse, you represent that you have the right to provide your submission as shareware to be used and shared by others without restriction, including permission from the third parties, as may be required. You also represent that the information contained in your submission is accurate and not libelous.