Application Form to be recognized as: “2019 Partner of World Birth Defects Day”
The organization requesting to be designated as “Participating Organization of World Birth Defects Day” to promote the World Birth Defects Day (WBDD):
Name of the organization *
Your answer
Country *
Your answer
Define your organization in one of the following *
Web Presence (e.g.,Website, Facebook Page, Twitter account) of the organization, please specify URL/Web addresses) *
Your answer
Who will serve as the organization’s liaison for WBDD?
Name and title *
Your answer
E-mail *
Your answer
Optional: Personal social media accounts of leading persons of the organization (please specify)
Your answer
In order to observe the WBDD we will:
Actively support WBDD by: *
Required
Disseminate information on birth defects by:
Organize local activities
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