APSR Members' Honour Roll
Nomination





Please enter the URL of a webpage that tells us who your mentor is.
(Profiles are typically on institution websites. If there is no such webpage, please enter their job title and institution name.)


A certificate will be emailed to your mentor.
Your mentor's

Consent
Yes, my mentor has agreed to be included on the Members' Honour Roll displayed on the APSR website.
No, my mentor does not want to be included on the Members' Honour Roll.

Please explain how your mentor has inspired and helped you personally.


Your name



(if known)

We are delighted that you are honouring your mentor's contribution and support for your career, and invite you to make to donation to the APSR. It will increase the amount available for activities in promoting healthcare training, research, education, and advocacy in the Asia-Pacific region.

I wish to donateUS$
40
60
80
100
Other (> US$100)
Contact address

To send you a receipt for your donation, please enter your contact address:











Public acknowledgement

We would like to publicly acknowledge your kindness in the next APSR Bulletin and on the Donors' webpage

Yes, I agree to my name appearing as a donor
in the next APSR Bulletin and on the webpage

If you agree, we can also show the name of your country (selected above) and institute, if you input its name here:

No, I do not want my name to appear as a donor
in the next APSR Bulletin or on the webpage

Personal acknowledgement

We would like to send you a Donor Card for your wallet. This is not a credit card, debit card, points card and has no function, except to remind you how grateful we are of your generosity.

Yes, I would like to receive a Donor Card
No, I do not want a Donor Card