EOI Form

Expression of Interest for conducting awareness programs exhibitions and clinics

Please fill the format “ACE-01” and send to the project office one month prior to the scheduled date

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Details of the coordinator

Home Address

Name :

House No. :

Street :

Town :

Postal code :

Contact Information

Email :

Land Phone :

Mobile 1 :

Mobile 2 :

Official Address

House No. :

Street :

Town :

Postal code :

Contact Information

Land Phone :

Details of the Location

House No. :

Street :

Town :

Postal code :

Click on a location on the map to select it. Drag the marker to change location.

Contact Information

Land Phone :

Details of the program

Purpose of the programs :

Scheduled date and time frame

From :

To :

No of participants expected :

Type of participants expected (gender ,education level etc) :

Other organizations involved :

Other organizations conducting clinics simultaneously / awareness programs stalls stand exhibitions :

Do you have the minimum requirements to conduct the program according to the format HTL /RE-1 :

Do you accept the terms and conditions of heal the life according to format HTL /LE1 :

I will take all necessary permissions from relevant authorities and will provide facilities to conduct the clinic

Heal the Life

Heals the Life

Cancer Prevention, Early Diognosis & Supportive Care in Sri Lanka

EOI Form

Expression of Interest for conducting awareness programs exhibitions and clinics

Form Submission Error!

Thank you!

Please Wait...

Details of the coordinator

Details of the program