JOIN THE NETWORK First name / non: Last Name / siyati Email Do you work directly in Haiti or do you support from outside of Haiti? / Èske ou travay dirèkteman an Ayiti oswa w ap sipòte an deyò de Ayiti?I work directly in Haiti (mwen travay dirèkteman an ayiti)I support from outside of Haiti (Mwen ap sipòte an deyò de Ayiti) Profession / ki pwofesyon ou:Doctor (doktè)Nurse (enfimyè)Dentist (dantis)Nurse Practitioner / PA ((enfimyè pratisyèn)Physical Therapist (fizyoterapis)Pharmacist (famasyen)Administrator (administratè)Other (lòt) Name of Organization / Non kote ou ap travay la: Where do you work? / Ki adres kote ou travay? Vilaj / seksyon kominal / Vil DepartmentArtibonite Central PlateauGrande Anse Nord Nord Est Nord OuestOuest Nippes Sud Sudest Do you work in multiple facilities? / Èske w ap travay nan plizyè enstitisyon /òganizasyon?Yes (wi)No (non) If yes, where? / si wi, ki kote? Do you have an area of specialty? / Èske ou gen yon spesyalite?Yes (wi)No (non) If yes, what is your specialty? / si wi, ki spesyalite ou? How did you hear about us? / koman ou tande pale de nou?Select value (Chwazi)Newsletter (Jounal)Webinar (Fòmasyon en liy)Professional Colleague Word of Mouth (De bouch a zòrèy)Social Media (Rezo sosyo)Other (Lòt) Additional information / Lòt enfòmasyon SubmitReset