Registration Form

Declaration of Real and Potential Conflict of Interest Form

According to the key principles of the WHO FCTC and the provisions of the FCTC Article 5.3 Guidelines, there is an irreconcilable conflict of interest between the commercial and other vested interests of the tobacco industry (any tobacco and tobacco product including electronic nicotine delivery systems [ENDS] and heated tobacco products [HTPs]). This form also covers the irreconcilable conflict of interest between the commercial and other vested interests of the alcohol and sugar-sweetened beverage industries, and those of public health. The Southeast Asia Tobacco Control Alliance (SEATCA) reserves the right to refuse or exclude registrants due to their involvement with the tobacco, alcohol, and sugar-sweetened beverage industries, or those furthering its interests.

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Personal Details
Note: all data submitted in this registration are covered by the relevant policies of the website administrators.

Country(Required)

Phone(Required)

Example: +66-1-234567

First Name(Required)

Last Name(Required)

Position/Title(Required)

Your designation in your organization

Organization(Required)

Organization or employer website (if employed)

If not employed or an independent consultant, please provide the website of an organization or entity that you are affiliated with in other ways (eg. university, association, volunteer group, etc). Please provide the COMPLETE URL so that the entry will be accepted by the form, for example: https://hpfhub.info/

Sector(Required)

Government

Academe

Civil Society

International Governmental Organization (IGO)

Other

Email address(Required)

Please provide the same email address used to sign up on HPF Hub E-Learning.

How did you learn about this course? Please indicate the organization or contact from whom you received the information, if applicable.(Required)

Declaration of Interest Form

By registering for this course, I confirm that I am not, or I have not been, in any way affiliated with the tobacco industry.(Required)

I confirm

I cannot confirm

By registering for this course, I confirm that I am not, or I have not been, in any way affiliated with the alcohol industry.(Required)

I confirm

I cannot confirm

By registering for this course, I confirm that I am not, or I have not been, in any way affiliated with the sugar-sweetened beverage industry.(Required)

I confirm

I cannot confirm

Please provide: Name of the tobacco, alcohol, or sugar-sweetened beverage industry-related commercial entity, period of involvement, nature of interest/relationship, and other relevant details. If not applicable, please write “None”(Required)

Pre-course Assessment

How would you rate your current understanding (knowledge) of innovative sustainable financing for health promotion?(Required)

Have you taken any courses or training on Health Promotion Fund before?(Required)

Yes

If yes, please provide the details of the course, including its name, and if possible, a link to the course?

How relevant is this topic to your role or work?(Required)

What made you enroll in this course?(Required)

What are you looking to get from this course?(Required)

Declaration of Real and Potential Conflict of Interest Form

Declaration of Interest Form

Pre-course Assessment

Register