Organisation Location Registration

Location details

Form description

This information requested here relates to the individual completing this registration form. Your name and job title will be displayed on the individual location page attached to your Organisation. Your email address and secondary account contact will be kept private.

Choose your Organisation from the list *

Choose a country *

Please select a country from the list

Location Type *

Choose whichever best describes the activity

Can you provide an address for this location? *

If possible, please provide an address.

Choose the nearest city (start typing to search)

Please enter the location address using the fields below

Address Line 1

Please use the English language version of your address as shown in Google Maps. Enter the first line of the address here.

Address Line 2

Please use the English language version of your address as shown in Google Maps. Enter the second line of the address here.

Address Line 3

Please use the English language version of your address as shown in Google Maps. Enter the third line of the address here.

City

The city where this location is based.

State/County

The state, county or administrative zone of this location.

ZIP/Postcode

Please enter the ZIP or postcode for this location.

Map Address

Is the location marker on the map below correct? *

If the location shown isn’t correct, choose ’No’, then use the search field above the map to search for the correct location. Alternatively, drag the marker to the correct location.

Location Map

Location map

The marker here shows your location. If it’s not quite right, drag it to the correct place. If you have entered an address above, that will not be affected.

Specify this location *

Name this location *

The location name given here will be shown in your NGO's account for internal use only. Please keep it simple and descriptive – e.g. Nairobi Office

Describe your activities at this location *

Please add a sentence or two to describe the purpose and activities of this location

Next section link

Next step

Account details

Title *

Choose your preferred form of address from the list

First / Given name *

Please enter your personal name (forename)

Second / Family name *

Please enter your family name (surname)

Suffix/es

Please enter any suffixes you wish to appear after your name – e.g. MD, PhD, FACS

Your job title

Your work email address *

Where possible, please use the email address assigned to you by your organisation – e.g. yourname@yourngo.org. This helps us verify your registration.

Phone Number

The phone number will only be visible to logged-in InterSurgeon members

How would you like to be addressed in emails? *

The name chosen here will be how you are addressed in email communications – it will only be seen by you

Secondary Account Contact

If possible, please list another member of your team as a secondary account contact in case you are unavailable:

Full name of secondary account contact

This information will be kept private and only used if we need to contact your organisation and are not able to reach you

Email address of secondary account contact

This information will be kept private and only used if we need to contact your organisation and are not able to reach you. Ensure that you have permission to add this information. Where possible, use the email address assigned by your organisation – e.g. name@yourngo.org.

How would you like your name to appear publicly on InterSurgeon? *

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