Title

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* 1. Title

Last name

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* 2. Last name

First name

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* 3. First name

Email address

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* 4. Email address

What is your current job title?

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* 5. What is your current job title?

What is your organisation name?

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* 6. What is your organisation name?

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

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

What is your telephone number (including country code)

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

What is your organisation's postal address?

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

Country

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* 10. Country

Your organisation's website

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* 11. Your organisation's website

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

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

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

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

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

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

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?

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* 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?

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

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

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

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

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