Open Health Tools New Committer Request Form

This form is for Project Leads and the CTO to request that the Open Health Tools Management Office process a new Committer. Please provide contact details for the new Committer. You must complete all fields marked with an asterisk.

First Name:*
Last Name:*
Company Name:*
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:
Project Name:*
Date of Committer Election: *
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