Evidence on Impact Mutual Learning Seminar 5-6 March, Noord-Brabant
Dear expert,

Please fill out this form to register for the Evidence on Impact Mutual Learning Seminar in Eindhoven, Noord-Brabant (NL).
This seminar will take place at the 5th and 6th of March.

This workshop is jointly organized by the CASA Interreg IVC project, the consortium of the ENGAGED Thematic Network Project (CIP ICT PSP) on Active & Healthy Ageing and the Action Group C2 of the European Innovation Partnership on Active & Healthy Ageing (EIP AHA) about Development Interoperable Independent Living Solutions.

For this workshop experts in the field of 'monitoring of impact of AHA solutions in daily life' have been invited.

For our guests from outside the Netherlands:
It is possible to apply for a reimbursement of your traveling & accommodation expenses in the registration form. Please, only fill out such a request if you are not able to cover your expenses otherwise. The ENGAGED project has limited budget for this.
More information about the reimbursement procedure can be provided by Daniel Fernandez Buckley.


With kind regards,

Also on behalf of Edwin Mermans (emermans@brabant.nl), Shabs Rajasekharan (srajasekharan@vicomtech.org),
Daniel Fernandez Buckley (Daniel.FernandezBuckley@ehma.org or +32 (0)2 502 6525)


Mariëlle Swinkels (m.swinkels@zorgtechnoservice.nl or +31 6 133 543 97 )

Content manager of ENGAGED Thematic Network project
Province of Noord-Brabant and member of CORAL

Full name *
Please enter your last name and surname
Your answer
Name of organisation *
Please enter the name of your organisation
Your answer
Email address *
Please enter your email address (and check it!)
Your answer
Telephone number *
Please enter your telephone number, e.g. + 32 2 12345678
Your answer
Region or city *
In what region or city are you based?
Your answer
Country *
In what country are you based?
Your answer
1. What type of stakeholder do you represent? *
Required
2a. Experience on monitoring impact of AHA solutions *
Please enter the domain in which you have collected evidence:
Required
2b. Experience on monitoring impact of AHA solutions *
Please enter the aspects on which evidence was gathered
Required
2c. Preferred topic of the three working groups *
Please click on the working group topic you prefer
3. Would you like to participate in the study visit to one of the testing grounds of Smarth Health? *
Click on the right answer.
Required
4a. Do you wish to apply for reimbursement of your travelling and accommodation costs? *
Reimbursement - under conditions - is possible up to a max. of 500,-. Only for guests outside the Netherlands.
Required
4b.Travel costs: please only answer this question if you request reimbursement!
Please fill out your travel expenses, including flights and other necessary transport
Your answer
4c. Accommodation costs: please only answer this question if you request reimbursement!
Please fill out your accommodation expenses, including daily expenses (maximum of 2 nights)
Your answer
5. Did you receive a "personal invitation only" of one of the consortium members of the CASA project and/or the ENGAGED project? *
Please click on the right answer.
Required
6. To which network organization of the ENGAGED consortium are you directly related to as a member or collaboration partner? *
Please click on the consortium partner you are directly related to or choose NONE if this is not the case.
Required
7. Remarks
Do you have any other remarks?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service