The information from questions 1 to 3 will be published on the WHO/Europe Physical activity web site.
1. Name of the institution/organization
(please give address, phone and generic email, if available): |
| * Name:
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| * Address:
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| * Phone:
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* Email:
(please give general email address of your institution)
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| * 2. Internet address:
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| * 3. Country:
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The information from questions 4 to 11 will not be published on the WHO/Europe Physical activity web site but will be made available to the other members of the Network |
* 4. Please briefly describe the main vision, aims and fields of work of your institution (this information will also be used to present your institution to the current members of the Network for final approval of your application):
Please provide at least 8-10 lines of text (75-100 words). |
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5. Contact person for the HEPA Europe Network
(please give name, position, address, phone, fax, and e-mail): |
| * Name:
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| * Gender:
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| * Position:
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| * Address:
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| * Phone:
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Fax:
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Email:
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| * 6. Status of the institution/organization: |
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If other, please specify:
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| 7. Please list the main funding source(s) of the institution/organization in descending order of relevance |
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| * 8. In which of these fields would you place your institution? |
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* 9. What is the main activity of the institution/organization
(please select up to three of the following/specify if necessary): |
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If other, please specify:
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* 10. Please briefly describe why you would like to join the HEPA Europe Network (this information will be used to present your institution to the current members of the Network for final approval of your application)
Please provide at least 8-10 lines of text (75-100 words). |
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| * 11. How did you learn about HEPA Europe? |
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If other, please specify:
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Before you submit the information, ensure you print this page for your own records.
Thank you very much for your kind cooperation!
