AMR Stakeholder Network
Please complete the form below, indicating your answers to the following questions:

- your organisation agrees with the Terms of Reference of the AMR Stakeholder network, organised under the auspices of the European Commission's Health Policy Platform
- your organisation supports the Roadmap for Action on Antimicrobial Resistance (2019-2024)
- your organisation consents to the data of its named representative (completed below) to be managed by the European Public Health Alliance (EPHA), for the purpose of communications regarding the AMR Stakeholder Network.

On completing the form below, your details will be added to the AMR Stakeholder Network mailing list if your organisation's application is successful.

Communication preferences can be updated at any time by contacting rosemary@epha.org or following any communication you receive regarding the network.

Please can you also send a one page outline explaining your organisation's motivation to join the network to zoltan@epha.org. Please also send any questions you may have about the network or the process to the same email address.

Email *
First name *
Last name *
Membership status *
Job title
Organisation
Type of organisation
If other, please describe below
Is your organisation registered on the EU Transparency Register?
Clear selection
If yes, what is your organisation's Transparency Register no
What is your or your organisation's knowledge and expertise on AMR?
I/your organisation agrees to abide by the Terms of Reference of the AMR Stakeholder Network *
Your organisation supports the Roadmap for Action on Antimicrobial Resistance (2019-2024) *
I agree for my contact details to be managed by the European Public Health Alliance for the purposes of communications regarding the AMR Stakeholder Network *
I agree that my organisation's name and logo may be published on the AMR Stakeholder Network web-page and may be used in any of the Network's publicity materials to promote its aims
Clear selection
Submit
Never submit passwords through Google Forms.
This form was created inside of epha. Report Abuse