Application Form to be recognized as: “2018 Participating Organization of World Birth Defects Day”
Please send the request application as soon as possible and not later than February 15, 2018
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
WBDD activities
In order to observe the WBDD, as all the other organizations promoting the WBDD, we will: *
Optional: We will also organize local activities
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