Form for Health and Environment Experts - Centre for Science and Environment (CSE)

FORM FOR HEALTH & ENVIRONMENT EXPERTS

Include your contact details in Health Links, a comprehensive directory of health professionals, Government/Multilateral Agencies and NGOs engaged in activities related to environment and health issues in India and across the world.

We need your help to make this updated edition of Health Links as comprehensive as possible. Give us information on the latest developments in your region, and the new initiatives undertaken by your group or organisation.

Take a few moments to complete the form given below. Please feel free to include names of others who you feel we have missed out, with their contact details.

(*Mandatory)

*Name:Dr Prof/ Mr/ Ms

*Name of Organisation:

Designation:

Department:

*Office Address:

*City:

Zip / Pin code:

*State:

*Country:

Telephone:

Fax:

Mobile:

*E-mail:

Website:

Residential Address:

City:

Zip / Pin code:

State:

Country:

Telephone:

Fax:

*Please select the type of organisation you are working for

Other

*Please select your activity (Please also specify area and discipline)

Details:

Other

*Please select your area of specialisation

Other

*Write a brief note highlighting the special features of the work (community projects/ research/ others) undertaken by you and/or your organisation

Mention the scope and objectives of your organisation / research project

Specify the geographical location, and levels of operation (village/district/city/town OR community/ hospital-based/ population based etc.) of your work

Please list publications to your credit, with complete references

Please outline, in detail, your research and its outputs

Please include any other information you would want to share with us

Name and address of other person (s) whom you would like to nominate to the Health Links-2 (click here to forward this questionnaire)

WRITE TO: Vikas Khanna, Database Unit
CENTRE FOR SCIENCE AND ENVIRONMENT
41, Tughlakabad Institutional Area, New Delhi - 110062, INDIA
Tel: +91 (011)-29955124, 29955125, 29956394, 29956401, 29956399; Fax: +91 (011) 29955879
E-mail: database@cseindia.org Website: www.cseindia.org