Apply for a World Stroke Day Award

World Stroke Campaign / World Stroke Campaign Awards / Apply for a World Stroke Day Award

First Name:*

Last Name:*

Title:

Email:*

Contact Telephone: (Including International Dialling Code)

Organization Name:*

Campaign Name:*

City:*

Country:

Date of Event/Activity:*

Please indicate the Award Category you wish to enter:*

Individual Achievement Award

Best Campaign in a Low or Middle Income Country

Best Campaign in a High Income Country

Are you nominating a person for this award?:

Yes No

First Name:

Last Name:

Describe how your campaign/event contributed to the International World Stroke Day theme. (200 words or less).

Describe how the campaign/event contributed to achieving local stroke campaign objectives. (200 words or less).

Describe the creative or innovative techniques your campaign used to raise awareness of the World Stroke Day theme with your audiences. (200 words or less).

Please upload files about your event:

Authorization

I authorize the World Stroke Campaign to publish my contact and event details online.

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