Member Registration

The member registration form below is designed to collect information on all HomeoNet members to store in a secure, searchable member database. The database can be searched by city, province and research interests and was designed to facilitate networking and contacts between HomeoNet members with similar interests and/or geographic locations. Your information will appear in the database exactly as it is input.

Please note that you may return at any time to update the information you provide by selecting the 'Update Member Information' option. You may also choose to complete any non-mandatory questions at a later time, if you do not have time to do so right now.

* are mandatory fields



MEMBER REGISTRATION FORM

1. First Name:*
2. Last Name:*
3. Address:
4. City:*
5. Province/State:*
6. Postal Code:
7. Country:*
8. Phone Number:
(999)999-9999
9. Fax:
(999)999-9999
10. Email:*
Your email address will become the username that you will use to log on to the HomeoNet web site. You will also be asked to create a unique password. HomeoNet will never sell or share our members’ email addresses with any other organization.
11. HomeoNet will send periodic updates about homeopathy research electronically via email. Would you like to be added to HomeoNet’s electronic mailing list?*
YesNo
12. Personal URL:
13. Organization:
14. Job Title:
e.g. professor, physician, homeopath
15. Qualifications:
e.g. MA, MD, PhD
16. Professional Affiliations:

17. Which of the following categories best describes your research?*
basic science research
clinical research
health services, systems and policy
population health

18. How would you describe yourself?*
academic researcher
administrator
clinician
educator
policy advisor or analyst
research staff
student
other,

19. From the following list, please identify at most FOUR areas which best describe your specific research interests. Please note the options have been grouped into three main categories. Your 4 choices may be in different categories, or all in the same general category.

(Medical) Condition Classifications
Cardiovascular disorders
Chronic illness in general
Dental and oral disorders
Dermatological disorders
Ear, nose and throat disorders
Endocrine and metabolic disorders
Gastrointestinal disorders
Genitourinary disorders
Hepatic and biliary disorders
Immunological disorders
Musculoskeletal disorders
Neurological disorders
Nutritional disorders
Obstetric/gynecological disorders
Oncological/hematological disorders
Ophthalmologic disorders
Pediatric disorders
Psychiatric disorders
Pulmonary disorders
Other,

Populations
Men
Women
Pediatric
Geriatric
Pregnant
Ethnic Groups
Other,

Health Services Research
Health law and ethics research
Health policy research
Health promotion/wellness/disease prevention
Integration of CAM and conventional care
Patient-practitioner relationships
Regulation of CAM products and practices
Other ,

20. How did you hear about HomeoNet?
I was referred by an outside organization (e.g., research network, professional association, college or university, government organization).
I was referred by an individual colleague or heard about HomeoNet through word of mouth.
I heard about HomeoNet while attending a conference or participating in a course or seminar.
I received an email from HomeNet inviting me to join.
I found HomeNet while performing an Internet search.
Other. Please Specify below:



21. Do you agree to have your information posted in HomeoNet’s secure membership database? Your information will only be accessible by HomeoNet members to facilitate networking between individuals interested in homeopathy research. We will never distribute your information to other groups or organizations.*
YesNo

22. The Canadian Interdisciplinary Network for CAM Research (IN-CAM)’s objectives are to facilitate, support and create high-quality, interdisciplinary, collaborative CAM research and build CAM research capacity in the following priority research areas: developing innovative methods to study the safety, efficacy and effectiveness of CAM; CAM health care delivery and policy; and knowledge transfer. As a partner of HomeoNet, IN-CAM will periodically send newsflashes of specific interest to CAM research. Do you want to be added to IN-CAM’s mailing list?
YesNo


User Login
To login to the HomeoNet web site, you will require both a username and a password. Your username will be the email address that you have entered above. Your password is chosen by you.
Password
(between 6 and 16 chars):*
Confirm password:*

14 Nov 08