* 1. YOUR ORGANIZATION


* 2. Details of key contact at your organization






* 3. Type of Organization (select more than one if appropriate)



* 4. Where does the organization operate?

* 5. What are your sources of funding? (Select all that apply)



* 6. Which diseases are represented in your organization?


7. How many people in your Country are affected by these diseases? (please estimate the number)






* 8. How many members does your organization have?



* 9. What services do you provide members?



* 10. Is your organization already registered with WAPO?

* 11. If not, is your organization interested in becoming a member of WAPO? If you answer Yes, this answer is considered an application for WAPO membership.

* 12. Would your organization be interested in attending WAPO Summit 2017 in Amsterdam? Please see further information on the Summits at www.facebook.com/wapo.org

* 13. Do you wish to receive our newsletter and other regular communication from WAPO?

14. How can WAPO assist your organization? After receipt of your information, WAPO will get in contact with you in order to schedule a teleconference to discuss how we may cooperate and help you and your organization.

15. Thank you for completing the survey. Your input is of value to us. If your organization has indicated an interest in becoming a member of WAPO further information will be forwarded after the survey has closed.