Registration

QCPC Collaborative Registration Form
*First Name
*Last Name
*Title
Profession
*Profession (Please select one or more relevant option(s))














If you selected 'other', please specify
Expertise
*Disciplinary Expertise (Please select one or more relevant option(s))








If you selected 'other', please specify
Workplace
*Workplace type (Please select one or more relevant option(s))







If you selected 'other', please specify
Workplace Details
*Organization Name
Department
*Address Line 1
Address Line 2
*City
State/Province
Zip/Postal Code
Country
Region
*Email Address
*Organization website
Topics Of Interest
Topics of interest (as related to quality of care) Indicating your areas of interest will help us to understand the breadth of participation in this network. (Please select one or more relevant option(s))





















If you selected 'other', please specify
Additional Information
Please provide the following information:
Public acknowledgement of QCPC Collaborative site membership
*To encourage the growth of the QCPC Collaborative community, we would like to include a list of registered members on the site. This list will not include members contact information. May we list your name and organisation on the QCPC Collaborative site? Please indicate your preference.

Linking the QCPC Collaborative website to your organization's website

We would like to link our website with other organizations with a focus on quality care in pregnancy & childbirth. Please indicate your preference from these options.

Link From Us
*Please indicate if you would be happy for us to include a link to your organization's website on the QCPC Collaborative website.

Link To Us
*Please indicate if you would be happy to include a link to the QCPC Collaborative on your organization's website.

Electronic news updates
*We would also like to keep you up to date on relevant research material and the activities of the QCPC Collaborative.

Join the QCPC Collaborative shared workspace
*We would like to offer you the opportunity to join the QCPC Collaborative shared workspace to access key resources & to take part in online discussions.

* denotes required field

Feedback

We welcome your feedback on how to improve this registration form. Please contact us at: info@qcpccollab.org

© The Collaborative on Quality Care for Pregnancy & Childbirth