Open Health Tools Individual Committer Questionnaire

To be completed by each new committer. This questionnaire is to be completed by each personseeking Committer status for an Open Health Tools project as an individual. If you have anyquestions, please send an email to the Open Health Tools Management Office. Fields marked with anasterisk are mandatory

* Have you read and do you agree to abide by the terms of the Open Health Tools Committer Guidelines?

Yes No
First Name:*
Last Name:*
Employer Name:*
Open Health Tools Project:*
Address:*
City:*
Province/State:*

Postal Code/ZIP:*
Country:*
Email Address:*
  You must provide us with either a phone number, a mobile number or both.
Phone Number: *
Mobile Number:*
Fax Number:
Projects
Date of Committer Election: *

* With regard to your participation as a committer in your project, are you participating in this projectas an individual or as part of your regular employment or duties as an independent contractor?

Individual Employee or Independent Contractor
Even if you are participating as an individual, if you are employed or are otherwise performingservices for a third party as an independent contractor, you may be bound by an agreement orapplicable law that transfers your IP rights to your employer or the company that has contracted yourservices. Such an agreement requires that your employer or contracting company provide consentto Open Health Tools to allow you to contribute code to your project under the EPL (http://www.eclipse.org/legal/epl-v10.html). In this case, please have your employer or contracting companycomplete the Open Health Tools Committer Employer Consent Form (http://www.openhealthtools.com/Documents/Form - Committer Employer Consent.pdf).
Please enter the result of the following mathematical question: 23 times 56
You may either print and mail this form or submit the form via email. Depending on your browser and email application, you may encounter problems transmitting this information through the use of the "Send form via email" button. If this happens, please copy the form into an email, complete it and sent ot to oht-mo at openhealthtools.org, or print the form and mail it to the address below.

Mailing Address
Open Health Tools, Inc.
11782 Rose Beach Line
Morpeth, Ontario
N0P 1X0
Canada