December 5, 2013
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.
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?
Name of the organisation or the coalition
Names of the ad hoc coalition partners involved with EFA
Name of EFA contact person
Website (if applicable)
Telephone(if different from above)
Fax (if different from above)
(if different from above)
PRINCIPLES FOR EFA MEMBERSHIP
Do you have members?
If ‘Yes’ who are they?
% health care professionals
if you have others please specify
If ‘No’ what type of organisation are you?
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?
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:
Are you a non-governmental organisation?
Are you affiliated with any political group or similar?
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:
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
Population of Country
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)
You must be logged in to post a comment.
If you would like to keep up to date with EFA’s activities, participation in events and other policy developments of interest to you, please subscribe to our monthly EFA eZine mailing and we will include you on our list:
EFA 35 Rue du Congrès
Belgium Fax - +32 (0) 2 218 3141 Email - firstname.lastname@example.org
Copyright EFA 2013