Partners In Health Supporter Survey Country: AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandColombiaComoros IslandsCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenZambiaZimbabwe Email:* First Name: Last Name: Address: City: State/Region/Province: AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY--AAAEAPASFMGUMHMPPRPWVI Zip / Postal Code:* Phone: I am a (please check all that apply): High school studentCollege studentCollege student in health professionGraduate studentGraduate student in health professionDoctorNurseHealth professional (other)Teacher/ProfessorBusiness person / entrepreneurPhilanthropistLawyerPublic servantJournalist Other: Please tell us your age:*Select...1415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899 I am interested in (check all that apply): Recruiting friends, colleagues and neighbors to support Partners In HealthHosting or attending Partners In Health eventsDonating to Partners In HealthContacting local leaders and legislators about health and social justice issuesContacting the press (writing a letter to the editor)Advocating for social justice in my own community Other activities: I would like to hear from Partners In Health about (check all that apply): Stories about individual patients and sitesUpdates on PIH's programsPIH's research and academic workPIH's training materials for other global health practitionersMore information about our policy and advocacy workBehind-the-scenes information about our staff and organizationWays that I can support PIH's workWhat others in the PIH community are doing to support our workOther efforts in the global health and social justice movementInvitations to events, speeches, fundraisers, etc.All of the above Other interest areas: I am particularly interested in Partners In Health work in (check all that apply): HaitiPeruRussiaUSARwandaLesothoMalawiMexicoGuatemalaBurundi I am particularly interested the following issues (check all that apply): Child healthCommunity health workersEconomic development and microfinanceFood, nutrition, agricultureFunding for global healthHIV/AIDSPrimary health careSocial justice in HaitiTuberculosisWater, housing, and educationWomen's health Other issues: I learned about Partners In Health through (check all that apply): Tracy Kidder's Mountains Beyond MountainsSchool course workA student groupA Partners In Health eventA friendTVPrint MediaRadioWeb Other source: How often do you visit our website (www.PIH.org)?: Every day A few times a week A few times a month Rarely Never Please share your feedback about our website: Please leave this field blank: * denotes required field