Thank you for your application. WAPO will respond within 2 weeks after receipt of your application.

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* 1. YOUR ORGANIZATION

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* 2. Structure of your organization:

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* 3. DETAILS OF KEY CONTACT AT YOUR ORGANIZATION
Representative needs to have patient experience themselves.

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* 4. TYPE OF ORGANIZATION (select more than one if appropriate)

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* 5. WHERE DOES THE ORGANIZATION OPERATE?

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* 6. WHAT ARE YOUR SOURCES OF FUNDING? (Select all that apply)

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* 7. WHICH DISEASES ARE REPRESENTED IN YOUR ORGANIZATION?

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* 8. PLEASE STATE DISEASE PREVELANCE IN YOUR COUNTRY AND SOURCE OF INFORMATION

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* 9. HOW MANY MEMBERS DOES YOUR ORGANIZATION HAVE?

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* 10. WHAT SERVICES DO YOU PROVIDE YOUR MEMBERS?

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* 11. REGISTERED MEMBERSHIP WITH WAPO

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* 12. WOULD YOUR ORGANIZATION BE INTERESTED IN NOMINATING ONE REPRESENTATIVE TO ATTEND THE ANNUAL WAPO SUMMIT? 
The delegate needs to have patient experience themselves, and be a responsible person/decision maker from your organization, who will report back to the organization. 

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* 13. HOW CAN WAPO ASSIST YOUR ORGANIZATION?
After receipt of your information, WAPO will contact you in order to organize a teleconference to discuss the membership of your organization and future activities.

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* 14. PRIVACY:    From May 25th, 2018 the European General Data Protection Regulation will be applicable  in all member states to harmonize data privacy laws across Europe.
WAPO would like to stay in touch and continue informing you about news, events, webinars as well as informative teleconferences and future developments.
We take the privacy of your data very seriously and therefore would like to ask you to consent to receiving these communications.  Please tick the communications you wish to receive.  You can withdraw your permission at any time by sending an email to muriel.marks@wapo.org

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* 15. Thank you for completing the survey. Your input is of value to WAPO! Should you have additional comments or require further information, please write to us in the box below.

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