Network Provider Registration Form

Title *

Name *

Middle Name

Surname *

Gender *

Email Address *

Telephone Number

Cellphone Number *

Country *

Entity Type *

Health Facility

Organisation

Organization Type

Facility / Organisation Name *

Position *

How did you hear about PATA? *

Are you engaged with a PATA Supported Programme? *

Yes

No

PATA Programme

I want to be added to the PATA WhatsApp group. *

Yes

No

I would like to receive quarterly PATA’s newsletter. *

Yes

No

Commitment Statement

By joining the PATA Network, I understand that I will be registered for the PATA Linking and Learning Hub, becoming part of a regional community of frontline healthcare providers committed to sharing learning, strengthening practice, and improving HIV and related health services for children, adolescents, young people, caregivers, and underserved communities.

As a PATA Network member, I agree to use the platform respectfully, safely, and responsibly. This means sharing information that is factual and appropriate, respecting confidentiality, not posting harmful, discriminatory, offensive, or misleading content, and not sharing material that breaches copyright, safeguarding, or other legal responsibilities.

When sharing stories, images, quotes, examples, or experiences from my work, I agree to protect the privacy, dignity, and safety of the people involved, and to only share content where appropriate consent has been obtained.

PATA may review, edit, reject, or remove content where needed to protect users, uphold platform standards, or comply with PATA policies. Resources shared on the Hub are for learning and educational purposes only and do not replace medical advice or national guidance.

I acknowledge that I will be registered on the PATA Hub. *

Agreement *

By registering for the PATA Network, I confirm that I have read and agree to uphold the Commitment Statement above, as well as PATA’s Privacy Policy and key organisational policies available on the Accountability page.

Add New Facility / Organization