Health policymaker update sign-up form

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<div class="article-wrap">
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<h1>Health policymaker update sign-up form</h1>
<h4></h4>
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<table style="width: 500px;" border="0" cellspacing="1" cellpadding="1" align="center" class="custom-form-style">
<tbody align="justify">
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<td><strong>To sign up for the SciDev.Net health policymaker monthly update, please provide all required details below.</strong> </p>
<style type="text/css">
#signup input ~ label.wrap {<br />
white-space: pre-wrap;<br />
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<form id="signup" action="https://dmtrk.net/signup.ashx" autocomplete="off" method="post" name="signup"><input name="ci_isconsentform" type="hidden" value="true" /> <input name="userid" type="hidden" value="83392" /> <input name="SIGf52b384639145fea7004cecee0ef3105284ae02138d4ed6178e2a1d2419e30ee" type="hidden" value="" /> <input name="addressbookid" type="hidden" value="58036150" /> <input name="ReturnURL" type="hidden" value="https://www.scidev.net/global/multimedia/thank-you-for-subscribing-for-health-policymaker-update.html" /> <input name="ci_userConsentText" type="hidden" value="Click this box to confirm that by filling and submitting this registration form, you indicate your consent to receive emails from SciDev.Net." /> <input id="ci_consenturl" name="ci_consenturl" type="hidden" value="" /></p>
<div><label class="wrap" for="email">Email</label> <input id="email" name="email" required="" type="text" aria-required="true" /></div>
<div>
<label class="wrap" for="COUNTRY">COUNTRY</label> <input id="COUNTRY" class="text" name="cd_COUNTRY" required="" type="text" aria-required="true" /></div>
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<label class="wrap" for="FULLNAME">FULLNAME</label> <input id="FULLNAME" class="text" name="cd_FULLNAME" required="" type="text" aria-required="true" /></div>
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<label class="wrap" for="GENDER">GENDER</label><select id="GENDER" name="cd_GENDER" aria-required="false"><option value="Female">Female</option><option value="Male">Male</option></select></div>
<p><input id="ci_userConsentCheckBox" name="ci_userConsentCheckBox" type="checkbox" /> <label for="ci_userConsentCheckBox">Click this box to confirm that by filling and submitting this registration form, you indicate your consent to receive emails from SciDev.Net. <em>Please visit our page covering <a href="https://www.scidev.net/global/content/policies.html" target="_self" rel="noopener noreferrer">our Privacy policies</a> for further information on how SciDev.Net uses personal data.</em></label></p>
<p><input id="btnsubmit" name="btnsubmit" type="submit" value="Subscribe" /></p>
</form>
<p><script type="text/javascript">

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<div style="text-align: center;"><em><strong>This is a product of SciDev.Net</strong></em></div>

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<p>This article was originally published on <a href="http://www.scidev.net/Global" target="_blank">SciDev.Net</a>. Read the <a href="https://www.scidev.net/global/multimedia/health-policymakers-update-sign-up-form/" target="_blank">original article</a>.</p>
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