Supplement Interest Form
Please complete the form to indicate interest in publishing a supplement with BCPHR. Learn more at BCPHR.org.
APPLICANT INFORMATION
Contact Email
*
example@example.com
Representative's First and Last Name
*
First Name
Last Name
Representative Position/Title
Organization
*
Organization's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization's Country
*
Proposed Supplement Title/Subject
*
Number of Articles Anticipated in the Supplement
No more than 5 articles
6-10 articles
11-15 articles
Proposed Supplement Addresses the Following Area(s) of Interest
*
Artistic Expression and Health
Body image
Children/Youth
Chronic Disease
Domestic Violence/Intimate Partner Violence
Environmental Health
Epi/Biostatistics
Global Health
Health Care Policy
Health Commnications and Technolgoy
Health Innovation
Human Rights
Immigration / Refugee Health
Infectious Diseases / Immunology
Maternal and Child Health
Mental Health
Mindfulness / Sleep / Rest
Non-infectious Disease
Nutrition
Obesity / Overweight
Occupational Health
Physical Activity
Policing / Surveillance
Quantitative Methods
Qualitative Methods
Racial / Ethnic Minority Health
Sexual / Gender Minorities / LGBTQIA+
Social Determinants of Health / Population Health
Substance Use
Terrorism
Violence (inc. Gun Giolence)
Women / Girl's Health
Other
Signature
*
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
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