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Who's where: a directory of Pacific HIV - hivpolicy.org

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Survey / Questionnaire<br />

Who’s Where?<br />

A DIRECTORY <strong>of</strong> <strong>Pacific</strong> <strong>HIV</strong> and STI Organisations / RÉPERTOIRE océanien du VIH et des autres IST<br />

To be included in the next address book, or to correct your current details, please fill out this form and send to:<br />

<strong>HIV</strong> & STI Section, Public Health Division, SPC, BP D5 Noumea Cedex, New Caledonia 98848.<br />

Fax: +687 263818; email: info_hivsti@spc.int<br />

Pour figurer dans le prochain répertoire, ou corriger les données existantes, remplissez et renvoyez-nous ce formulaire à<br />

l’adresse suivante : Section VIH & IST, Division de la santé publique, CPS, BP D5 Nouméa Cedex, Nouvelle-Calédonie 98848.<br />

Fax: +687 263818 ; email: info_hivsti@spc.int<br />

Organisation: …………………………………………………………………………………………………………………<br />

Contact person/Responsable : ………………………………………………………………………………………………<br />

Address / Adresse : ……………………………………………………………………………………..……………………<br />

Telephone / Téléphone : ………………………………………………… Fax: ………………………..……………………<br />

Email / Courriel : ……………………………………………………………………………………………………………<br />

Website / Site internet : ……………………………………………………………………………………………………<br />

Type <strong>of</strong> <strong>org</strong>anisation (please tick as appropriate) / Type d’<strong>org</strong>anisation (cocher la case correspondante) :<br />

F Governmental <strong>org</strong>anisation / Organisation gouvernementale<br />

F Non-governmental <strong>org</strong>anisation / Organisation non gouvernementale<br />

F International agency / Organisation internationale<br />

F Private sector / Secteur privé<br />

F Faith-based <strong>org</strong>anisation / Organisation confessionnelle<br />

F Research institution / Institut de recherche<br />

F Educational agency / Organisme de formation<br />

F Documentation and information centre / Centre d’information et de documentation<br />

F Network or umbrella group / Organisme de coordination<br />

F Organisation <strong>of</strong> people living with <strong>HIV</strong> / Association de personnes vivant avec le VIH<br />

F Pr<strong>of</strong>essional body or <strong>org</strong>anisation / Organisation de pr<strong>of</strong>essionnels<br />

F Other (please indicate) / (Autre (préciser) ………………………………………………………<br />

Please indicate location <strong>of</strong> any branch/field <strong>of</strong>fices <strong>of</strong> your <strong>org</strong>anisation / Veuillez indiquer l’adresse d’éventuels bureaux<br />

décentralisés ou d’antennes:<br />

9

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