Governance | EUnetCCC

Centre and Contact Information

Centre name:

Country:

City:

Street and Number:

ZIP Code:

Contact Details

Administrative Contact

The designated person at your centre, responsible for completing the Interest form and uploading all required documentation. This individual will be the sole point of contact for your centre and will receive an account to manage and submit the necessary documents for the application process.

Warning: The Administrative contact is the person who will receive credentials to log into the platform and follow the application. The Administrative Contact must be unique to each Cancer Centre.

Name:

Surname:

Qualification:

Email address:

Phone number:

Legal Representative

An authorised individual with the legal authority to sign official documents on behalf of your centre.

Name:

Surname:

Qualification:

Email address:

Phone number:

Primary Representative to Interim Assembly

The official delegate appointed by your centre to represent it in the Interim Assembly. Each centre may designate only one Primary Representative, who will hold voting rights during Assembly meetings.

Name:

Surname:

Qualification:

Email address:

Phone number:

Deputy Representative

A backup delegate who may attend and vote in the Interim Assembly only if the Primary Representative is unavailable.

Name:

Surname:

Qualification:

Email address:

Phone number:

Data Processing Agreement

By submitting this form, you agree to the processing of the provided personal and institutional data for the purpose of evaluating your centre's eligibility and facilitating communication regarding the EU network of CCCs. View the Data Processing Agreement here.

I agree to the processing of my data as described above.

CCC Certification

Does your centre currently hold a valid CCC certification under the EUCCC, OECI, or DKH scheme?

Yes No

Interest Form

Centre Information

Centre and Contact Information

Contact Details

Data Processing Agreement

Eligibility Assessment