JLA Affiliates - James Lind Alliance by liuhongmei

VIEWS: 9 PAGES: 2

									JLA Affiliates: 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

Simply fill out this form and send it back to the JLA (details overleaf).

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...




                                                                                             Please turn over
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?
Individual    □

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.

* 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.       □



Thank you for your interest. Please return this form to the JLA:

JLA Affiliates
James Lind Alliance Secretariat
James Lind Initiative
Summertown Pavilion
Middle Way
Oxford OX2 7LG

Or email it to Katherine Cowan, consultant to the JLA: katherine@katherinecowan.net.

We will get back to you to confirm your affiliation as soon as possible.

								
To top