By submitting this form, the information you input into the title, name and affiliation fields will be made publicly visible on the list of signatories page. The further professional info field is optional, but any information you input into this field will also visible within the same list.
The information you put into the email field will not be published. We may, however, use your email address to let you know further information about the Declaration (such as media coverage). By inputting your email address and submitting the form, you agree to this.
The information you put in the country of residence field will not be published. The purpose of gathering this information is to demonstrate support for protection of freedom of conscience in health care, with the aim of attracting the attention of legislators and policy makers in the UK, EU, USA, Canada, and elsewhere.
If you wish to update your details or be removed from the list, please contact David S. Oderberg (firstname.lastname@example.org).
Sign the Declaration in Support of Conscientious Objection in Health Care
If you do not have a title and/or professional affiliation then please enter “none” into these fields.