portrait of James Lind

THE JAMES LIND ALLIANCE

Tackling treatment uncertainties together

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APPLICATION FORM

The JLA Affiliates programme is for organisations and individuals who identify strongly with the JLA and who want to express their support for, be involved in or simply be kept informed of the JLA’s activities.

Becoming an Affiliate is quick and free. It means you’ll:

  • be kept up-to-date about JLA activity

  • be the first to know about JLA research and new initiatives

  • receive our popular bi-monthly newsletter

  • be part of a network of organisations and individuals interested or active in patient and clinician involvement in research priority setting

Please answer the following questions. Questions marked with a * are compulsory.

Shared values

*1. Affiliating to the JLA means you have an interest in and support for the aim of the JLA: to champion the involvement of patients and clinicians in research priority setting.

Does this apply to you?

Yes         No

2. Feel free to tell us a bit more about your interest in this area...

Contact details

Please provide your contact details so we can keep in touch with you: these will be stored securely and will not be passed on to any third parties.

*3. Do you wish to affiliate as an individual or an organisation?

        

4. Name


5. Position (if applicable)

6. Organisation/group (if applicable)

*7. Email

OR
Postal Address

 

8. Website (if applicable)

JLA website

Affiliates have the option of being listed on the JLA website.

*9. Are you happy to be listed as an Affiliate on the JLA website, or would you rather remain anonymous?

I am happy to be listed as an Affiliate on the JLA website.

I would prefer to remain anonymous.

If you encountered any problems while completing this form please email patkinson@lindalliance.org

Users join our mailing list voluntarily when signing up through a form on our website or by email. The information you provide will only be used to provide you with information on the work of the James Lind Alliance or other relevant information. It will not be disclosed to a third party without your permission. If at any time you would like your details to be removed from the mailing list please contact us by email: patkinson@lindalliance.org

For further information please contact Patricia Atkinson patkinson@lindalliance.org

 

 



Copyright 2012 James Lind Alliance