IPHU Registration

Personal Information


Contact Information

Professional Information

Please describe your educational background
Please describe your current ocupation
Please describe your involvement with health activism
Why do you want to participate in this course and what do you hope to be able to do afterwards?
Please list areas of particular interest relating to health and access to medical products


Please provide contact details (name, occupation, email, contact number (preferably mobile) of at least one reference who can speak about your health background/activism.

Language Skills

Online Course Necessities

(Kindly note that the organisers will take the final decision between 9 AM GMT and 12 PM GMT)