| GDC Membership Application Form

Thank you for your interest in GDC!

We are delighted that you have decided to become a member. It is easy to sign up, just follow these simple steps:

Please provide basic information about yourself and your professional background.

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Name*

Title First Last

Preferred Email*

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Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Degree(s)*

Title, Employer

Medical Specialty*

Facility Type*

Private Practice
Public Facility
University
Non-Governmental Organization / Non-Profit
Other

How did you hear about GDC?

What draws you to GDC and the opportunity to be a member?

If you are currently engaged in reproductive health advocacy - attempting to influence policy in government or health institutions - would you describe your work?

Please upload your Curriculum Vitae (CV), bio, or a summary of recent activities*

Accepted file types: pdf, doc, odf, txt, Max. file size: 10 MB.

Please not that .docx files will not work.

Please include a link to your professional profile

All GDC members are required to subscribe the GDC Charter.

Global Doctors for Choice’s work is rights-based, aligned with the international human rights framework, and focuses on sexual and reproductive health, while respecting the dignity and the autonomy of the health decisions of all people. All members subscribe to the following articles of the Charter:

Global Doctors for Choice is a global network of member physicians whose overarching goal is to improve reproductive health outcomes and to enhance women’s autonomy to control their reproductive lives.

Global Doctors for Choice is committed to promoting exchange, support, and collaboration among physicians around the world, so that they can actively work towards ensuring that all people have access to comprehensive reproductive health care, with respect for autonomy and the information and freedom of choice to make their own reproductive health decisions.

Members will draw upon their experience in diverse medical disciplines to harness their medical credibility and scientific expertise as health care providers dedicated to the best medical interests of women and men from all over the world.

Members will actively advocate to make comprehensive, evidence-based reproductive health care, including abortion, accessible for women worldwide.

I hereby subscribe to the GDC Charter.*

Yes

GDC Membership is subject to the approval of the GDC Board of Managers, as well as a check to ensure that the information provided is correct. The Board of Managers may decide to conduct additional basic research on your application and/or may consult with third parties about your application.

I authorize GDC to check that the information I provided is correct.*

Yes

We also request you to carefully read and sign this General Release, Consent, and Waiver:

I hereby release and forever discharge Global Doctors for Choice and its officers, directors, employees, volunteers, agents, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may have in the future, whether known or unknown, of any nature, relating to or arising out of my selection or service as a volunteer member with GDC whether or not due to GDC negligence, strict liability, or any other breach or fault. This includes but is not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss, or cost.

I agree to the GDC General Release, Consent, and Waiver*

Yes

GDC Membership is free of charge. The requested voluntary annual membership is USD $50, and we would welcome an additional contribution.

Note: If you are based in Brazil and want to contribute to GDC, please first contact your bank to request they accept the associated international fee. Thank you!

You may contact [email protected] for further information.

Membership & Contribution

Membership Contribution*

One-time contribution*

You can make a one-time contribution in addition to a recurring annual membership.

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card*

American Express

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* If you have trouble submitting a contribution, please select “Not at this time” above to continue with your application and then contact GDC directly at [email protected] for help.

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