Add Clinician / Researcher European Cleft Organisation

*I consent to the details I am providing in this form being uploaded onto the European Cleft Gateway, a directory of resources supporting care, treatment and collaboration in areas of common clinical and scientific interest in the field of cleft lip and palate. I understand the details will be publicly accessible on the Gateway website www.gateway.europeancleft.org . The Gateway is administered by the European Cleft Organisation, a registered charity in the Netherlands www.europeancleft.org
I attest that the details I am providing are true, accurate and current.

I consent:

*I understand I can remove consent at any time and ask for my details to be modified or removed by contacting the European Cleft Organisation.

*ECO is actively engaged in complying with all the new regulatory requirements of the General Data Protection Regulations.

*I would like to receive newsletters and other mailings from the European Cleft Organisation

I consent:

*If I am adding details of persons other than myself in my hospital/cleft centre/research unit, I acknowledge that I am authorised to do so:

Yes

* All fileds marked in blue are mandatory in order for your information to be registred in the gateway.

Country *

Address *

City *

Zip Code *

Name *

Profession *

Employer and/or organization affiliated to *

Your Email *

Your Phone *

Website

Are you a clinician or a researcher, or both:
ClinicianResearcherBoth

If you are a Clinician, please specify your clinician specialty:

If you have chosen "Other" from above, please specify:

If you are a Researcher, please specify your area of research:

Specify Your Area/s of Research

If you have chosen "Other" from above, please specify:

Description of your professional experience and practice

Current or past research (please enter links to your research if you are happy to share them)

If your employer is NOT cleft centre are you working with or affiliated to a cleft centre?: YesNo

If Yes, please write the cleft center / team name:

Is this cleft centre / team already registered on the Gateway?

YesNo