International

Prader-Willi Syndrome

Organization

APPLICATION FORM FOR I.P.W.S.O. MEMBERSHIP 

1.      Name of National PWS Association  ……………………………………………………………

      Date of Registration ………………………………………………..

      Address:  …………………………………………………………………………………………

      Tel No. ………………………. Fax No. …………………….. E mail: …………………………

2.      How many members are there in your PWS Association?  ………………..

Your Association should appoint one parent and one professional delegate to represent your country in IPWSO. Their names, addresses, telephone, fax and E mail numbers should be given below and they will be added to our lists. It is essential that they are able to correspond in English and that they are able to organise the distribution of IPWSO material within your country. They should also be prepared to attend the General Assembly held every 3 years in conjunction with International PWS conferences, or assign a proxy.

3.      IPWSO Parent Delegate:  Name ………………………………………………………………

Address: ………………………………………………………………………………………………

Tel No. ………………………. Fax No. …………………….. E mail: ……………………………...

4.      IPWSO Professional Delegate:  Name …………………………………………………………

Address: ………………………………………………………………………………………………

Tel No. ………………………. Fax No. …………………….. E mail: ……………………………...

Signed:  …………………………………………………… President National PWS Association

Name  (Printed)  ……………………………………

Thank you for your application. This should be sent to:

IPWSO , Secretary

c/o BIRD FOUNDATION ONLUS,
Via Bartolomeo Bizio 1,
1-36023 Costozza (VI) Italy

e-mail: president@ipwso.org

Scientific Advisors:  Dr. Susanne Blichfeldt (Denmark), Dr. Dan Driscall (USA),
Dr. Tony Holland (UK), Prof. Martin Ritzen (Sweden)