2016-2017 Global Health Society Membership Registration

We look forward to working with you as a member of the Unite For Sight Global Health Society. Thank you for your commitment to improving health globally!

Global Health Society Training

1. Please read the Global Health Society Manual to learn more about society procedures and ideas for society activities.
2. Watch this short video about Unite For Sight programs in Ghana, Honduras, and India: Unite For Sight: A Global Health Movement.

Personal Information

First Name

Last Name

Email Address

Birthdate

Gender

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone Number

Academic Information

School Name (Where you are currently enrolled and will participate in Global Health Society)

Expected Graduation Date

School year for which you are applying to become a member

Have you previously been involved as a member or officer of a Global Health Society (previously called Unite For Sight Chapter)?

If yes, with which school?

Have you previously been involved with Unite For Sight?

Please specify the type of involvement (click all that apply)

Yes, Global Health & Innovation Conference

Yes, Global Impact Corps

Yes, Social Entrepreneurship Institute

Yes, Other

If "Other", please note in what capacity were you involved?

Are you applying for an officer position? If yes, you will thereafter submit the officer application in your portal, and you’ll be able to log into your portal after submitting this application and the associated required $24 donation.

Declaration

I understand that in order to become a Unite For Sight Global Health Society Member, I am required to submit a $24 donation at the time that the application is submitted. The $24 donation is equivalent to a $2 commitment per month to provide eye care to patients living in extreme poverty.
I understand and give permission for my name and email to be shared with other members of the Society at my school for the purpose of collaboration and contact regarding Society activities.

I have read and accept the above declaration.

Name (Electronic Signature)