Contact the Steering Committee Form Question Title * 1. What is your name? Question Title * 2. What is your email address? Question Title * 3. Country of practice Afghanistan Albania Algeria Andorra Angola Antigua & Deps Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia Herzegovina Botswana Brazil Brunei Bulgaria Burkina Burundi Cambodia Cameroon Canada Cape Verde Central African Rep Chad Chile China Colombia Comoros Congo Congo {Democratic Rep} Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland {Republic} Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea North Korea South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar, {Burma} Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russian Federation Rwanda St Kitts & Nevis St Lucia Saint Vincent & the Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Question Title * 4. Please inform on specific topics / issues / conditions you suggest being developed as educational campaigns, as part of the wider initiative 1: 2: 3: 4: 5: Question Title * 5. Which educational format do you prefer? 1-High 2 3 4- Low Conference Sessions Conference Sessions 1-High Conference Sessions 2 Conference Sessions 3 Conference Sessions 4- Low Webcasts of Conference Sessions Webcasts of Conference Sessions 1-High Webcasts of Conference Sessions 2 Webcasts of Conference Sessions 3 Webcasts of Conference Sessions 4- Low Online Workshops Online Workshops 1-High Online Workshops 2 Online Workshops 3 Online Workshops 4- Low Accredited online eLearning courses Accredited online eLearning courses 1-High Accredited online eLearning courses 2 Accredited online eLearning courses 3 Accredited online eLearning courses 4- Low Websites / Online sources Websites / Online sources 1-High Websites / Online sources 2 Websites / Online sources 3 Websites / Online sources 4- Low Newsletters Newsletters 1-High Newsletters 2 Newsletters 3 Newsletters 4- Low Articles Articles 1-High Articles 2 Articles 3 Articles 4- Low Question Title * 6. Would you like to nominate yourself to become a tutor / speaker in any of the upcoming EIP activities in relation to the Initiative? Yes No Question Title * 7. Please describe any ideas and views on the campaign, and in particular on any future activities you are proposing ? (up to 400 words) Done