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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/1999/REC-html401-19991224/loose.dtd"> <html> <head><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://phishare.org:80/register/","20090910001107","https://web.archive.org/","web","/_static/", "1252541467"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <script src="/web/20090910001107js_/http://phishare.org/utm/__utm.js" type="text/javascript"></script> <title> Population and Health InfoShare Register to be a Partner</title> <meta name="Keywords" content="population health information public help knowledge sharing"> <meta name="Description" content="Sharing Knowledge to Improve Public Health Worldwide"> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"> <style type="text/css"> @import url(/web/20090910001107cs_/http://phishare.org/styles.css); /*IE and NN6x styles*/ </style> <script type="text/javascript" src="/web/20090910001107js_/http://phishare.org/lib.js"></script> <script type="text/javascript"></script> </head> <body class="sectionPartners"> <div id="container"> <div id="branding"> <h1><a href="/web/20090910001107/http://phishare.org/" title="Population Health InfoShare: Sharing Knowledge to Improve Public Health Worldwide."><img src="/web/20090910001107im_/http://phishare.org/images/logo-banner.gif" width="495" height="78" border="0" alt="Population Health InfoShare: Sharing Knowledge to Improve Public Health Worldwide."></a></h1> </div>  <table cellpadding="0" cellspacing="0" border="0" width="100%"> <tr> <td><div id="nav"> <ul> <li id="menu-home"><a href="/web/20090910001107/http://phishare.org/">Home</a></li> <li id="menu-documents"><a href="/web/20090910001107/http://phishare.org/documents/">Documents</a></li> <li id="menu-events"><a href="/web/20090910001107/http://phishare.org/events/">Events</a></li> <li id="menu-partners"><a href="/web/20090910001107/http://phishare.org/partners/">Contributing Partners</a></li> <li id="menu-about"><a href="/web/20090910001107/http://phishare.org/about/">About Us</a></li> <li id="menu-login"><a href="/web/20090910001107/http://phishare.org/login/"><strong>Partner Login</strong></a></li> </ul> </div></td> <td><div id="bookbag"><img src="/web/20090910001107im_/http://phishare.org/images2/bookbag.gif" alt="bookbag" width="11" height="12" border="0"> <a href="/web/20090910001107/http://phishare.org/bookbag/">My BookBag</a>:  0 Documents</div></td> </tr> <index-this> <tr> <td valign="top" style="padding-right: 6px;"> <h2>Register to be a Partner</h2> <p>Join Population and Health InfoShare and share your ideas and information. Complete the form below to request membership, or for more information about becoming a Partner see this list of <a href="/web/20090910001107/http://phishare.org/faq/">Frequently Asked Questions</a>.</p> <p>Please note, however, there are some restrictions. Membership is free, but only open to organizations with science-based research, policy, or program findings to share. Posting of information of a promotional, commercial, fundraising and/or primarily cause-related nature is not permitted. More details on rules of use are available at <a href="/web/20090910001107/http://phishare.org/about/terms.php">www.phishare.org/about/terms.php</a>. By applying for membership, your organization accepts and agrees to abide by InfoShare's "terms of use."</p> <form action="/web/20090910001107/http://phishare.org/register/index.php" method="POST" name="showform_7" enctype="multipart/form-data" onsubmit="">  <input type="hidden" name="PHPSESSID" value="689e86b6a7f04a5f04e35048a3caf3e4"/> <input type="hidden" name="a" value=""/>  <input type="hidden" name="pxdb[params][id]" value=""/> <input type="hidden" name="pxdb[params][dt]" value="7"/> <p>Fields marked with <span style="color: red">*</span> are required.</p> <h2>Information about your organization</h2> <table border="0" cellpadding="4" cellspacing="4">  <tr style=""> <th align="right" valign="top"> <span style="color: red">*</span>Organization Name </th> <td> <input type="text" name="pxdb[data][name]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> <span style="color: red">*</span>Type </th> <td> <select name="pxdb[data][type]"> <option value="">[choose]</option> <option value="1">Government agency or ministry</option> <option value="2">Hospital, clinic, or other health care institution</option> <option value="3">International or regional agency</option> <option value="4">Media company or organization</option> <option value="5">Nongovernmental organization</option> <option value="7">Public or private sector donor agency</option> <option value="8">University or research institute</option> <option value="6">Private-sector agency or company</option> <option value="9">Other</option> </select> </td> </tr>   <tr style=""> <th align="right" valign="top"> <span style="color: red">*</span>Description </th> <td colspan="2" align="left"> <textarea name="pxdb[data][description]" wrap="virtual" cols="40" rows="10"></textarea> </td> </tr>   <tr style=""> <th align="right" valign="top"> Additional Information </th> <td> <textarea name="pxdb[data][desc3]" wrap="virtual" cols="40" rows="10"></textarea> </td> </tr>   <tr style=""> <th align="right" valign="top"> <span style="color: red">*</span>Address Line 1 </th> <td> <input type="text" name="pxdb[data][address1]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> Address Line 2 </th> <td> <input type="text" name="pxdb[data][address2]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> <span style="color: red">*</span>City </th> <td> <input type="text" name="pxdb[data][city]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> State or Province </th> <td> <input type="text" name="pxdb[data][state]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> Postal Code </th> <td> <input type="text" name="pxdb[data][zipcode]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> Organization's "Home" Country </th> <td> <select name="pxdb[data][ctry_op]"> <option value="">[choose]</option> <option value="1">Afghanistan</option> <option value="2">Albania</option> <option value="3">Algeria</option> <option value="4">Andorra</option> <option value="5">Angola</option> <option value="6">Antigua and Barbuda</option> <option value="7">Argentina</option> <option value="8">Armenia</option> <option value="9">Australia</option> <option value="10">Austria</option> <option value="11">Azerbaijan</option> <option value="12">Bahamas, The</option> <option value="13">Bahrain</option> <option value="14">Bangladesh</option> <option value="15">Barbados</option> <option value="16">Belarus</option> <option value="17">Belgium</option> <option value="18">Belize</option> <option value="19">Benin</option> <option value="20">Bhutan</option> <option value="21">Bolivia</option> <option value="22">Bosnia and Herzegovina</option> <option value="23">Botswana</option> <option value="24">Brazil</option> <option value="25">Brunei</option> <option value="26">Bulgaria</option> <option value="27">Burkina Faso</option> <option value="28">Burma</option> <option value="29">Burundi</option> <option value="30">Cambodia</option> <option value="31">Cameroon</option> <option value="32">Canada</option> <option value="33">Cape Verde</option> <option value="34">Central African Republic</option> <option value="35">Chad</option> <option value="36">Chile</option> <option value="37">China</option> <option value="38">Colombia</option> <option value="39">Comoros</option> <option value="40">Congo (Brazzaville)</option> <option value="41">Congo (Kinshasa)</option> <option value="42">Costa Rica</option> <option value="43">Cote d'Ivoire</option> <option value="44">Croatia</option> <option value="45">Cuba</option> <option value="46">Cyprus</option> <option value="47">Czech Republic</option> <option value="48">Denmark</option> <option value="49">Djibouti</option> <option value="50">Dominica</option> <option value="51">Dominican Republic</option> <option value="52">Ecuador</option> <option value="53">Egypt</option> <option value="54">El Salvador</option> <option value="55">Equatorial Guinea</option> <option value="56">Eritrea</option> <option value="57">Estonia</option> <option value="58">Ethiopia</option> <option value="59">Fiji</option> <option value="60">Finland</option> <option value="61">France</option> <option value="62">Gabon</option> <option value="63">Gambia, The</option> <option value="64">Georgia</option> <option value="65">Germany</option> <option value="66">Ghana</option> <option value="67">Greece</option> <option value="68">Grenada</option> <option value="69">Guatemala</option> <option value="70">Guinea</option> <option value="71">Guinea-Bissau</option> <option value="72">Guyana</option> <option value="73">Haiti</option> <option value="74">Holy See</option> <option value="75">Honduras</option> <option value="76">Hungary</option> <option value="77">Iceland</option> <option value="78">India</option> <option value="79">Indonesia</option> <option value="80">Iran</option> <option value="81">Iraq</option> <option value="82">Ireland</option> <option value="195">Israel</option> <option value="83">Italy</option> <option value="84">Jamaica</option> <option value="85">Japan</option> <option value="86">Jordan</option> <option value="87">Kazakhstan</option> <option value="88">Kenya</option> <option value="89">Kiribati</option> <option value="90">Korea, North</option> <option value="91">Korea, South</option> <option value="92">Kuwait</option> <option value="93">Kyrgyzstan</option> <option value="94">Laos</option> <option value="95">Latvia</option> <option value="96">Lebanon</option> <option value="97">Lesotho</option> <option value="98">Liberia</option> <option value="99">Libya</option> <option value="100">Liechtenstein</option> <option value="101">Lithuania</option> <option value="102">Luxembourg</option> <option value="103">Macedonia, The Former Yugoslav R</option> <option value="104">Madagascar</option> <option value="105">Malawi</option> <option value="106">Malaysia</option> <option value="107">Maldives</option> <option value="108">Mali</option> <option value="109">Malta</option> <option value="110">Marshall Islands</option> <option value="111">Mauritania</option> <option value="112">Mauritius</option> <option value="113">Mexico</option> <option value="114">Micronesia, Federated States of</option> <option value="115">Moldova</option> <option value="116">Monaco</option> <option value="117">Mongolia</option> <option value="191">Montenegro</option> <option value="118">Morocco</option> <option value="119">Mozambique</option> <option value="120">Namibia</option> <option value="121">Nauru</option> <option value="122">Nepal</option> <option value="123">Netherlands</option> <option value="124">New Zealand</option> <option value="125">Nicaragua</option> <option value="126">Niger</option> <option value="127">Nigeria</option> <option value="128">Norway</option> <option value="129">Oman</option> <option value="130">Pakistan</option> <option value="131">Palau</option> <option value="194">Palestinian Territory</option> <option value="132">Panama</option> <option value="133">Papua New Guinea</option> <option value="134">Paraguay</option> <option value="135">Peru</option> <option value="136">Philippines</option> <option value="137">Poland</option> <option value="138">Portugal</option> <option value="139">Qatar</option> <option value="140">Romania</option> <option value="141">Russia</option> <option value="142">Rwanda</option> <option value="143">Saint Kitts and Nevis</option> <option value="144">Saint Lucia</option> <option value="145">Saint Vincent and the Grenadines</option> <option value="146">Samoa</option> <option value="147">San Marino</option> <option value="148">Sao Tome and Principe</option> <option value="149">Saudi Arabia</option> <option value="150">Senegal</option> <option value="190">Serbia</option> <option value="151">Seychelles</option> <option value="152">Sierra Leone</option> <option value="153">Singapore</option> <option value="154">Slovakia</option> <option value="155">Slovenia</option> <option value="156">Solomon Islands</option> <option value="157">Somalia</option> <option value="158">South Africa</option> <option value="159">Spain</option> <option value="160">Sri Lanka</option> <option value="161">Sudan</option> <option value="162">Suriname</option> <option value="163">Swaziland</option> <option value="164">Sweden</option> <option value="165">Switzerland</option> <option value="166">Syria</option> <option value="192">Taiwan</option> <option value="167">Tajikistan</option> <option value="168">Tanzania</option> <option value="169">Thailand</option> <option value="170">Togo</option> <option value="171">Tonga</option> <option value="172">Trinidad and Tobago</option> <option value="173">Tunisia</option> <option value="174">Turkey</option> <option value="175">Turkmenistan</option> <option value="176">Tuvalu</option> <option value="177">Uganda</option> <option value="178">Ukraine</option> <option value="179">United Arab Emirates</option> <option value="180">United Kingdom</option> <option value="181">United States</option> <option value="182">Uruguay</option> <option value="183">Uzbekistan</option> <option value="184">Vanuatu</option> <option value="185">Venezuela</option> <option value="186">Vietnam</option> <option value="187">Yemen</option> <option value="188">Zambia</option> <option value="189">Zimbabwe</option> </select> </td> </tr>   <tr style=""> <th align="right" valign="top"> <span style="color: red">*</span>Telephone </th> <td> <input type="text" name="pxdb[data][phone]" value="" size="20"/> </td> </tr>   <tr style=""> <th align="right" valign="top"> Fax </th> <td> <input type="text" name="pxdb[data][fax]" value="" size="20"/> </td> </tr>   <tr style=""> <td align="right" valign="top"> Your website URL </td> <td> <input type="text" name="pxdb[data][webaddress]" value="" size="40"/> </td> </tr>   <tr style=""> <td align="right" valign="top"> <b>Regional Focus</b> <br><small>Select multiple entries<br> by ctrl+Click(PC)<br>or Apple+Click(Mac)</small> </th> <td> <select name="pxdb[data][region_focus][]" size="5" multiple> <option value="10">Global</option> <option value="2">Asia/Pacific</option> <option value="7">Europe</option> <option value="3">Latin America/Caribbean</option> <option value="5">Middle East/North Africa</option> <option value="8">North America</option> <option value="4">Sub-Saharan Africa</option> </select> </td> </tr>   <tr style=""> <td align="right" valign="top"> <b>Countries of Focus</b> <br><small>Select multiple entries<br>by ctrl+Click(PC)<br> or Apple+Click(Mac)</small> </th> <td> <select name="pxdb[data][ctry_focus][]" size="5" multiple> <option value="1">Afghanistan</option> <option value="2">Albania</option> <option value="3">Algeria</option> <option value="4">Andorra</option> <option value="5">Angola</option> <option value="6">Antigua and Barbuda</option> <option value="7">Argentina</option> <option value="8">Armenia</option> <option value="9">Australia</option> <option value="10">Austria</option> <option value="11">Azerbaijan</option> <option value="12">Bahamas, The</option> <option value="13">Bahrain</option> <option value="14">Bangladesh</option> <option value="15">Barbados</option> <option value="16">Belarus</option> <option value="17">Belgium</option> <option value="18">Belize</option> <option value="19">Benin</option> <option value="20">Bhutan</option> <option value="21">Bolivia</option> <option value="22">Bosnia and Herzegovina</option> <option value="23">Botswana</option> <option value="24">Brazil</option> <option value="25">Brunei</option> <option value="26">Bulgaria</option> <option value="27">Burkina Faso</option> <option value="28">Burma</option> <option value="29">Burundi</option> <option value="30">Cambodia</option> <option value="31">Cameroon</option> <option value="32">Canada</option> <option value="33">Cape Verde</option> <option value="34">Central African Republic</option> <option value="35">Chad</option> <option value="36">Chile</option> <option value="37">China</option> <option value="38">Colombia</option> <option value="39">Comoros</option> <option value="40">Congo (Brazzaville)</option> <option value="41">Congo (Kinshasa)</option> <option value="42">Costa Rica</option> <option value="43">Cote d'Ivoire</option> <option value="44">Croatia</option> <option value="45">Cuba</option> <option value="46">Cyprus</option> <option value="47">Czech Republic</option> <option value="48">Denmark</option> <option value="49">Djibouti</option> <option value="50">Dominica</option> <option value="51">Dominican Republic</option> <option value="52">Ecuador</option> <option value="53">Egypt</option> <option value="54">El Salvador</option> <option value="55">Equatorial Guinea</option> <option value="56">Eritrea</option> <option value="57">Estonia</option> <option value="58">Ethiopia</option> <option value="59">Fiji</option> <option value="60">Finland</option> <option value="61">France</option> <option value="62">Gabon</option> <option value="63">Gambia, The</option> <option value="64">Georgia</option> <option value="65">Germany</option> <option value="66">Ghana</option> <option value="67">Greece</option> <option value="68">Grenada</option> <option value="69">Guatemala</option> <option value="70">Guinea</option> <option value="71">Guinea-Bissau</option> <option value="72">Guyana</option> <option value="73">Haiti</option> <option value="74">Holy See</option> <option value="75">Honduras</option> <option value="76">Hungary</option> <option value="77">Iceland</option> <option value="78">India</option> <option value="79">Indonesia</option> <option value="80">Iran</option> <option value="81">Iraq</option> <option value="82">Ireland</option> <option value="195">Israel</option> <option value="83">Italy</option> <option value="84">Jamaica</option> <option value="85">Japan</option> <option value="86">Jordan</option> <option value="87">Kazakhstan</option> <option value="88">Kenya</option> <option value="89">Kiribati</option> <option value="90">Korea, North</option> <option value="91">Korea, South</option> <option value="92">Kuwait</option> <option value="93">Kyrgyzstan</option> <option value="94">Laos</option> <option value="95">Latvia</option> <option value="96">Lebanon</option> <option value="97">Lesotho</option> <option value="98">Liberia</option> <option value="99">Libya</option> <option value="100">Liechtenstein</option> <option value="101">Lithuania</option> <option value="102">Luxembourg</option> <option value="103">Macedonia, The Former Yugoslav R</option> <option value="104">Madagascar</option> <option value="105">Malawi</option> <option value="106">Malaysia</option> <option value="107">Maldives</option> <option value="108">Mali</option> <option value="109">Malta</option> <option value="110">Marshall Islands</option> <option value="111">Mauritania</option> <option value="112">Mauritius</option> <option value="113">Mexico</option> <option value="114">Micronesia, Federated States of</option> <option value="115">Moldova</option> <option value="116">Monaco</option> <option value="117">Mongolia</option> <option value="191">Montenegro</option> <option value="118">Morocco</option> <option value="119">Mozambique</option> <option value="120">Namibia</option> <option value="121">Nauru</option> <option value="122">Nepal</option> <option value="123">Netherlands</option> <option value="124">New Zealand</option> <option value="125">Nicaragua</option> <option value="126">Niger</option> <option value="127">Nigeria</option> <option value="128">Norway</option> <option value="129">Oman</option> <option value="130">Pakistan</option> <option value="131">Palau</option> <option value="194">Palestinian Territory</option> <option value="132">Panama</option> <option value="133">Papua New Guinea</option> <option value="134">Paraguay</option> <option value="135">Peru</option> <option value="136">Philippines</option> <option value="137">Poland</option> <option value="138">Portugal</option> <option value="139">Qatar</option> <option value="140">Romania</option> <option value="141">Russia</option> <option value="142">Rwanda</option> <option value="143">Saint Kitts and Nevis</option> <option value="144">Saint Lucia</option> <option value="145">Saint Vincent and the Grenadines</option> <option value="146">Samoa</option> <option value="147">San Marino</option> <option value="148">Sao Tome and Principe</option> <option value="149">Saudi Arabia</option> <option value="150">Senegal</option> <option value="190">Serbia</option> <option value="151">Seychelles</option> <option value="152">Sierra Leone</option> <option value="153">Singapore</option> <option value="154">Slovakia</option> <option value="155">Slovenia</option> <option value="156">Solomon Islands</option> <option value="157">Somalia</option> <option value="158">South Africa</option> <option value="159">Spain</option> <option value="160">Sri Lanka</option> <option value="161">Sudan</option> <option value="162">Suriname</option> <option value="163">Swaziland</option> <option value="164">Sweden</option> <option value="165">Switzerland</option> <option value="166">Syria</option> <option value="192">Taiwan</option> <option value="167">Tajikistan</option> <option value="168">Tanzania</option> <option value="169">Thailand</option> <option value="170">Togo</option> <option value="171">Tonga</option> <option value="172">Trinidad and Tobago</option> <option value="173">Tunisia</option> <option value="174">Turkey</option> <option value="175">Turkmenistan</option> <option value="176">Tuvalu</option> <option value="177">Uganda</option> <option value="178">Ukraine</option> <option value="179">United Arab Emirates</option> <option value="180">United Kingdom</option> <option value="181">United States</option> <option value="182">Uruguay</option> <option value="183">Uzbekistan</option> <option value="184">Vanuatu</option> <option value="185">Venezuela</option> <option value="186">Vietnam</option> <option value="187">Yemen</option> <option value="188">Zambia</option> <option value="189">Zimbabwe</option> </select> </td> </tr>   <tr style=""> <th align="right" valign="top"> Upload logo image </th> <td> <span>Choose a file to upload.<br/><input type="file" name="pxdb[data][new_logofile]" value="" size="40"></span> </td> </tr> <tr style=""> <td align="left" valign="top" colspan="2"> Logos must be JPG or GIF format and 120x140 or smaller. </td> </tr>  </table> <h2>Account information</h2> <table border="0" cellpadding="4">  <tr style=""> <th align="left" valign="top" colspan="2"> <span style="color: red">*</span>Contact e-mail </th> </tr> <tr> <td colspan="2"> <input type="text" name="pxdb[data][email]" value="" size="40"/> </td> </tr>   <tr style=""> <th align="left" valign="top" colspan="2"> <span style="color: red">*</span>Choose Password </th> </tr> <tr> <td colspan="2"> <input type="password" name="pxdb[data][password]" value="" size="20"/> <br/><input type="password" name="pxdb[data][password_verify]" value="" size="20"/> (verify) </td> </tr>   <tr style=""> <th valign="top" colspan="2" align="left"> <span style="color: red">*</span>Admin E-mail(s) </th> </tr> <tr> <td valign="top" colspan="2"> <p>Enter one or more e-mail addresses below, one address per line. These addresses will receive administrative e-mails when you add or modify documents or events.</p> <textarea name="pxdb[data][admin_emails]" wrap="virtual" cols="20" rows="5"></textarea> </td> </tr>   <tr style=""> <th valign="top" colspan="2" align="left"> <span style="color: red">*</span>URL Short Name </th> </tr> <tr> <td colspan="2"> <p> Choose a shortened version of your organization name or acronynm to create a simple URL for your Partner page. <b>Please do not use spaces or punctuation.</b><br/> Ex: "myOrganization" will create the URL <nobr>"http://www.phishare.org/partners/myOrganization/"</nobr> </p> </th> </tr> <tr> <td colspan="2"> <input type="text" name="pxdb[data][idnum]" value="" size="40"/> </td> </tr> <tr> <td valign="top" colspan="2"> <p style="padding:6px;background:#eea;">After you submit your request, you will be notified by e-mail of your account activation.</p> <input type="submit" name="subbtn" class="goButton" value=" Submit Request " onclick="this.form['a'].value='save'; 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