In what country is your organisation based? * - Select - England Scotland Northern Ireland Wales UK-wide Afghanistan Albania Algeria American Samoa Andaman and Nicobar Islands Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Azores Bahamas Bahrain Balearic islands Bali Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Borneo Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cabrera Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Corsica Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Easter Island Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland Formentera France French Guiana French Polynesia Gabon Galapagos Islands Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Hawaii Honduras Hong Kong Hungary Ibiza Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau SAR Macedonia Madagascar Madeira Islands Majorca Malawi Malaysia Maldives Mali Malta Margarita Island Marshall Islands Martinique Mauritania Mauritius Mayotte Menorca Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of Korea (S. Korea) Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin/Sint Maarten Saint Pierre and Miquelon aint Vincent and the Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia" "Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tibet Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British and USA) Wake Island and the US Pacific Islands Wallis and Futuna Islands Western Sahara Yemen Zambia Zanzibar Zimbabwe
Postcode of your organisation *
What is the name of your organisation/body/university *
Organisation’s website url
Facebook name
Twitter name
Which category best describes your organisation? * - Select - Aligned with Department of Agriculture, Environment and Rural Affairs (DEFRA) and its non-departmental public bodies National NHS organisation Regional NHS organisation (e.g CCG, Local commissioning group) NHS Trust/Health and Social Care Trust (NI) Professional Organisation NHS Primary Care Primary care other (eg hospice; community hospital; out of hours) GP Practice Hospital (Secondary Care) Community Pharmacy company Community Pharmacy Premises Private Healthcare Government (National) Government (Local) Ambulance Trust University Charity Non-departmental public body Professional body Animal health professional body Public Health England, Wales, Scotland (eg HPT, Centre, or team/programme) Veterinary and animal care Food and farming Other
IF other, please specify *
For NHS organisations in England, which CCG is your organisation most closely aligned to? - Select - NHS Airedale, Wharfedale and Craven NHS Ashford NHS Aylesbury Vale NHS Barking and Dagenham NHS Barnet NHS Barnsley NHS Basildon and Brentwood NHS Bassetlaw NHS Bath and North East Somerset NHS Bedfordshire NHS Bexley NHS Birmingham CrossCity NHS Birmingham South and Central NHS Blackburn with Darwen NHS Blackpool NHS Bolton NHS Bracknell and Ascot NHS Bradford City NHS Bradford Districts NHS Brent NHS Brighton and Hove NHS Bristol NHS Bromley NHS Bury NHS Calderdale NHS Cambridgeshire and Peterborough NHS Camden NHS Cannock Chase NHS Canterbury and Coastal NHS Castle Point and Rochford NHS Central London (Westminster) NHS Central Manchester NHS Chiltern NHS Chorley and South Ribble NHS City and Hackney NHS Corby NHS Coventry and Rugby NHS Crawley NHS Croydon NHS Cumbria NHS Darlington NHS Dartford, Gravesham and Swanley NHS Doncaster NHS Dorset NHS Dudley NHS Durham Dales, Easington and Sedgefield NHS Ealing NHS East and North Hertfordshire NHS East Lancashire NHS East Leicestershire and Rutland NHS East Riding of Yorkshire NHS East Staffordshire NHS East Surrey NHS Eastbourne, Hailsham and Seaford NHS Eastern Cheshire NHS Enfield NHS Erewash NHS Fareham and Gosport NHS Fylde & Wyre NHS Gloucestershire NHS Great Yarmouth and Waveney NHS Greater Huddersfield NHS Greater Preston NHS Greenwich NHS Halton NHS Hambleton, Richmondshire and Whitby NHS Hammersmith and Fulham NHS Hardwick NHS Haringey NHS Harrogate and Rural District NHS Harrow NHS Hartlepool and Stockton-on-Tees NHS Hastings and Rother NHS Havering NHS Herefordshire NHS Herts Valleys NHS Heywood, Middleton and Rochdale NHS High Weald Lewes Havens NHS Hillingdon NHS Horsham and Mid Sussex NHS Hounslow NHS Hull NHS Ipswich and East Suffolk NHS Isle of Wight NHS Islington NHS Kernow NHS Kingston NHS Knowsley NHS Lambeth NHS Lancashire North NHS Leeds North NHS Leeds South and East NHS Leeds West NHS Leicester City NHS Lewisham NHS Lincolnshire East NHS Lincolnshire West NHS Liverpool NHS Luton NHS Mansfield and Ashfield NHS Medway NHS Merton NHS Mid Essex NHS Milton Keynes NHS Nene NHS Newark & Sherwood NHS Newbury and District NHS Newham NHS North & West Reading NHS North Derbyshire NHS North Durham NHS North East Essex NHS North East Hampshire and Farnham NHS North East Lincolnshire NHS North Hampshire NHS North Kirklees NHS North Lincolnshire NHS North Manchester NHS North Norfolk NHS North Somerset NHS North Staffordshire NHS North Tyneside NHS North West Surrey NHS Northern, Eastern and West Devon NHS Northumberland NHS Norwich NHS Nottingham City NHS Nottingham North and East NHS Nottingham West NHS Oldham NHS Oxfordshire NHS Portsmouth NHS Redbridge NHS Redditch and Bromsgrove NHS Richmond NHS Rotherham NHS Rushcliffe NHS Salford NHS Sandwell and West Birmingham NHS Scarborough and Ryedale NHS Sheffield NHS Shropshire NHS Slough NHS Solihull NHS Somerset NHS South Cheshire NHS South Devon and Torbay NHS South East Staffordshire and Seisdon Peninsular NHS South Eastern Hampshire NHS South Gloucestershire NHS South Kent Coast NHS South Lincolnshire NHS South Manchester NHS South Norfolk NHS South Reading NHS South Sefton NHS South Tees NHS South Tyneside NHS South Warwickshire NHS South West Lincolnshire NHS South Worcestershire NHS Southampton NHS Southend NHS Southern Derbyshire NHS Southport and Formby NHS Southwark NHS St Helens NHS Stafford and Surrounds NHS Stockport NHS Stoke on Trent NHS Sunderland NHS Surrey Downs NHS Surrey Heath NHS Sutton NHS Swale NHS Swindon NHS Tameside and Glossop NHS Telford and Wrekin NHS Thanet NHS Thurrock NHS Tower Hamlets NHS Trafford NHS Vale of York NHS Vale Royal NHS Wakefield NHS Walsall NHS Waltham Forest NHS Wandsworth NHS Warrington NHS Warwickshire North NHS West Cheshire NHS West Essex NHS West Hampshire NHS West Kent NHS West Lancashire NHS West Leicestershire NHS West London NHS West Norfolk NHS West Suffolk NHS Wigan Borough NHS Wiltshire NHS Windsor, Ascot and Maidenhead NHS Wirral NHS Wokingham NHS Wolverhampton NHS Wyre Forest NHS Newcastle Gateshead NHS Coastal West Sussex NHS Guildford and Waverley
NHS organisations in Scotland which health board is your organisation closely aligned to? - Select - Ayrshire and Arran Borders Dumfries and Galloway Fife Forth Valley Grampian Greater Glasgow and Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles (Golden Jubilee National Waiting Times Hospital, Healthcare Improvement Scotland, National Services Scotland, NHS Education for Scotland, Scottish Ambulance Service, State Hospital)
For NHS organisations in Wales which health board is your organisation closely aligned to? - Select - Betsi Cadwaladr University Local Health Board Hywel Dda University Local Health Board Abertawe Bro Morgannwg University Local Health Board Cardiff & Vale University Local Health Board Cwm Taf University Local Health Board Aneurin Bevan University Local Health Board Powys Teaching Health Board Velindre NHS Trust
For Health and Social Care Organisations in Northern Ireland, which Local Commissioning Group or Trust area is our organisation based in? - Select - Belfast Health & Social Care Trust Northern Heath & Social Care Trust Southern Health & Social Care Trust South Eastern Health & Social Care Western Health & Social Care Trust
How did you find out about registering your organisation to participate in World Antibiotic Awareness Week activities - Select - Public Health England/NHS Scotland/Public Health Wales/ Public Health Agency or Health and Social Care Board in Northern Ireland CCG or Trust CEO Local council/authority University or school Colleague Professional organisation's email/newsletter Social media Other
IF other please specify *
What is your role in the organisation? (or on which senior colleague’s behalf are you completing the registration) - Select - Chief Exec/Chair of an NHS organisation/public body Chief Exec/Chair / President/Comms lead of a professional organisation Director (Clinical/Exec) Comms Lead of NHS organisation Comms lead - Other Chief Pharmacist/Head of medicines management Non-exec director Manager Senior Manager/Very Senior Manager Facility’s director/manager/head of Operations director/manager/head of Events director/manager/head of Internal communication’s director/manager Trustee Board member Lecturer/Educator/teacher Dean of School Student leading a local campaign on campus President, committee member of a student organisation Governor AMR/AMS/ID Professional lead Other
IF other please specify *
Do you know if one or more senior leaders /executives (e.g exec/non-exec directors, chief pharmacists, heads of medicines management, director of nursing, medical director) in your organisation chosen their personal Antibiotic Guardian pledge * - Select - Yes at least 1 Yes 1-5 senior leaders No but will be working on this for WAAW No I am not sure
If yes, to above, please state the job title(s) of the execs/senior leaders that have chosen their individual Antibiotic Guardian pledge *
I have completed the registration on behalf of a senior colleague * - Select - Yes No
If yes, to above, please state the job title(s) of the execs/senior leaders that you have registered on behalf of *
Your Email Address *
If different please provide the email address of the main lead for WAAW/EAAD/Antibiotic awareness activities in your organisation
Please use this space to share details of other activities that you have planned and are not listed in table 1. Or to provide additional comments/feedback
If your organisation (England only) will carry out a local awareness campaign and you/other member of staff can regularly wear the Antibiotic Guardian lanyard or badge, please provide the postal address to send these to.
