* 1. Title

* 2. Last name

* 3. First name

* 4. Email address

* 5. What is your current job title?

* 6. What is your organisation name?

* 7. What is your organisation's general email address? (If same as above leave blank)

* 8. What is your telephone number (including country code)

* 9. What is your organisation's postal address?

* 10. Country

* 11. Your organisation's website

* 12. Which area(s) of the CBR Matrix are you working in? (tick all relevant)

* 13. Your organisation's mission (mission statement or a sentence describing your work)

* 14. What is your organisation type? Tick the one most relevant.

* 15. We need to know where to locate you in the CAN Directory. Is your work within a region of your country, or national, or do you work in more than one country of Africa?

* 16. If more than one country please tick the region(s) your organisation is working in below:

* 17. Thank you very much for completing this registration form. May we contact you if we need more information?

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