Complete the form below to join the Members-Only section on the #COVIDActionCollab platform. This section will have a number of features like the exchange for materials, and  funding, volunteer listing and members-only toolkit. This will also enable you to connect with other members. Please complete the form to submit your application. We will process the application and respond with your credentials ASAP.

Please note
1. All fields are mandatory
2. This form is for organisations. If you are an individual volunteer, please complete the Volunteer Form.
3. Only one person should complete the form on behalf of an organisation.
4. Only one person from each organisation can register. If you want multiple users from your organisation, please use the same user name and password

Partner/Organisation/Network Name*
Partner/Organization/Network Headquarters Location (Country)*
Partner/Organization/Network Type* (Select all that apply, hold Ctrl/Cmd and click to select multiple options)
Point of Contact (POC) Name *
POC Phone*
POC Email*
What domain(s) do you operate in?* (Select upto 4)
Which communities do you work with?* (Select all that apply)
What response areas can you contribute to?* (Select all that apply)
What resources/partners do you need?* (Select all that apply)
How did you find out about us? Check all that apply*

Please ensure that the file is a jpg or a png with a white background and a maximum resolution of 500px x 500px

©2020 Swasti Health Catalyst


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