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Joining form for the English Deprescribing Network
1.
Joining form for the English Deprescribing Network
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1.
Question 1.
PRIVACY AND DATA SHARING NOTICE
This privacy notice explains how EDeN collects personal data and how we use it.
By completing this form, you are adding yourself to our database of members.
We will not sell your personal data - this database will exist as a spreadsheet that cannot be publicly accessed.
Under GDPR, you can request to access the data we hold about you. This refers to any detail that you provide when filling in this online form. You may also request for your data to be removed from our database.
If you have any requests or queries, please contact us at
eden@deprescribingnetwork.com
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Yes, I agree
2.
Question 2.
Which of the following do you wish to do?
Join EDeN as a new member
Update my current membership details
Unsubscribe as a member
3.
Question 3.
Which option below most aligns with your current professional sector?
If you work across multiple sectors, please select the option which represents where you spend the majority of your time.
Academic/ University
Commercial/ Private sector
Governmental (includes national, regional, local levels)
Non-governmental/ Not for Profit/ Charity
Primary Care
Secondary Care
Not currently working
Other (please specify):
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Input box for - Other (please specify):
4.
Question 4.
In what capacity are you interested in EDeN?
Advocate
Allied Health Professional (includes those with a direct patient care role and who may have application to broader public health outcomes but are NOT MEDICAL, DENTAL, NURSING OR PHARMACY PROFESSIONALS)
Business or Service Administrator (includes those who are responsible for administration, policy, planning and/ or management of a service)
Dental Professional
Medical Professional
Nursing Professional
Patient or patient representative
Pharmacy Professional
Research or academic
Other (please specify):
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Input box for - Other (please specify):
5.
Question 5.
Please indicate from the selection below, which specialities you are most interested in (can select multiple options)
Cancer
Cardiovascular
Care of older people
Diabetes and endocrinology
Falls prevention
Frailty
Gastroenterology
General medicine
Infections and immunology
Mental Health
Musculoskeletal
Neurosciences and the senses
Paediatrics
Palliative Care
Renal
Respiratory
None of the above
Other (please specify):
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Input box for - Other (please specify):
6.
Question 6.
How would you like to be involved with EDeN? (can select multiple options)
Receive email news about EDeN (please provide an email address in the form below)
Receive notifications when we are doing deprescribing events or initiatives
I would like to be part of EDeN discussion forums and I will provide my email address to facilitate this
Participate in working groups for projects
I would like to be involved in all aspects of EDeN
Other (please specify):
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Input box for - Other (please specify):
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To get involved in EDeN please provide us with your details
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Title
Full name
Email (optional but required if you want to receive emails from us or partake in our forum)
Please confirm your email address
Geographical area
How did you hear about us
Anything else you would like to tell us:
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