ANACARE Application form



    Center Information


    Center Address





    Center Contact Data




    Department Information



    Department Head


    Department Deputy



    Application

    Dear Professor Antonella Muraro,

    I wish to join the ANACARE Centers of Reference and Excellence and hereby apply for our center to become a ANACARE.


    "32 ANACARE requirements and deliverables" and confirm that our center fulfils the requirements and deliverables.

    Please note: Some of the information listed above (including the center’s name and address, contact information for patients, website and logo) may be published on the website on the website of Global Allergy And Asthma Excellence Network. You can find examples of our centers' profiles on ADCARE page: https://global-allergy.network/anacare/#find-adcare or on https://global-allergy.network/cores/#aa29203c

    My center is already a member of the following Global Allergy and Asthma Excellence networks (required):



    Verify Information

    Please review and verify your information before submitting your application. If you need to change your submitted information, click "Previous" at the bottom of this page to go back.


    Center Information

    Center Name:

    Center Address:

    Center Contact Data:

    Department Data:


    Application

    Please explain why you want to become an Anaphylaxis Center of Reference and Excellence:

    Consent: I have read the "32 ANACARE requirements and deliverables" and confirm that our center fulfils the requirements and deliverables.

    Signature


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