Community Health Worker Registration
First name:
*
Last name:
*
Username(Phone Number):
*
Enter a valid phone number start with 07.....
National ID Number:
*
National ID must be 16 digits
Date of Birth:
*
Gender:
*
Select gender
Male
Female
Other
Rather not say
Address:
*
Hospital:
*
Select a hospital
CHUK
Nyarugenge DH
Kibagabaga H
Rwamagana PH
Kabgayi DH
Ruhengeri RH
Gisenyi DH
Health center:
*
Select a health center
Hospital ID:
*
Email:
Password:
*
Password confirmation:
*
Enter the same password as before, for verification.
I agree with the
Terms and conditions
.
Register
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