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HAI Individual Member Registration
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First Name (*)
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Last Name (*)
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Gender (*)
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Profession (*)
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Organization/Institution of Learning
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Job Titile
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Telephone
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Email
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Full Mailing Adress
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Personal background and interest in the field of medicine
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Specific ares of interest in which you are keenly interested or involved
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Reasons for wishing to be part of the HAI Africa network (Please explain how the network can best serve you)
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How did you hear about HAI Africa
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Contact Information

Health Action International (HAI) Africa Office
4th Floor, Top Plaza off Kindaruma Road Suite 4-2
P.O Box Nairobi - Kenya
Tel: +254 20 2692973 ext 108, Cell phone: + 254 0733 398654.
E-mail:info@haiafrica.org, Web:http:// www.haiafrica.org