COSA Country Enquiry for Rotary Family Health Days
Information gathering to host a RFHD in your COSA Country
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Email *
Full Name of Proposed Contact Person for RFHD *
Country *
Rotary District *
Rotary Country Representative *
Rotary District Governor *
Level of Interest in Hosting a Health Day Campaign *
Not Interested
Very Interested
Rate your relationship with the in-country Department of Health *
Very good
Rate your relationship with the in-country CDC *
Very good
Which month and year are you considering piloting a heath day campaign *
Budget Considerations: Please check which of the following options/contacts/ suggestions you would have in-country to fund the Health Day Campaign *
Full Name of Rotary Leader Submitting Form *
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