Membership Form

Please fill in electronically all grey areas of this form, print out and send this form together with the required documents and a cover letter signed by your chairperson indicating that you want to join EFA and accept the EFA Statutes and Internal rules to EFA Office, 35 Rue du Congrès, 1000 Brussels, Belgium.
Please see page 4 for the membership criteria.

Organisation details

Coalition Membership

Are you joining as a coalition with other organisations in your country?

 

If ‘Yes’ is it a registered coalition?

 

If ‘No’ please make sure that each of the ad hoc coalition partners fills in one application form, attach the documents required and nominate the same contact person and delegate to general meeting.

 

Which coalition member pays the membership fee to EFA?

 

 

Contact Details

Name of the organisation or the coalition

 

Names of the ad hoc coalition partners involved with EFA

 

Name of EFA contact person

 

Full Address

 

Telephone

 

Fax

 

E-mail

 

Website (if applicable)

 

 

Delegate to the EFA General Meeting of Members

Name

 

Telephone(if different from above)

 

Fax (if different from above)

 

E-mail
(if different from above)

 

 

PRINCIPLES FOR EFA MEMBERSHIP

Represented Diseases

 

 

Accountability and Democracy

Membership:

Do you have members?

 

If ‘Yes’ who are they?

 

 

% patients/carers

 

% health care professionals

 

% others

if you have others please specify

 

If ‘No’ what type of organisation are you?

 

 

Governance:

The highest governing body of your organisation is:

 

Who elects your governing body?

 

If not elected by patients/carers or their elected representatives, how is patient perspective incorporated in the policy making of your organisation?

 

 

Legitimacy

Registration number:

 

Year and country of registration:

 

Is your organisation’s status non-profit/charity?

 

Please attach a copy of your Statutes/Constitution or indicate here the website address where it is available:

 

 

Indepedence and transparency

Are you a non-governmental organisation?

 

Are you affiliated with any political group or similar?

 

Source of income: Please answer in % Amount  

Membership fees

 

Government

 

Fundraising

 

Sponsors

 

Name of Current Sponsors

 

Or other (Please specify)

 

Please attach your last approved financial accounts or indicate here the website address where they are available:

 

Aims and Objectives

What are your organisations aim/mission and main objectives?

 

Are you willing to actively take part within the EFA network?

 

Do you have Specific expectations for the EFA network

 

 

Statistical Questions

 

Population of Country

 

Representation

 

How many members do you have?

 

How many local member organisations/branches?

 

How many FTE’s (full time equivalents)?

 

How many volunteers?

 

Prevelance(Answer in % of Population)

 

 

Asthma

 

COPD

 

Allergy

 

Allergic Rhinitis

 

Atopic Eczema

 

Urticaria

 

Food Allergy

 

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