EDTECH WORKSHOP

Registration Form

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1. Title/Titre (Required.)

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2. Surname/Nom (Required.)

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3. Other Names/Prénoms (Required.)

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4. Gender/Sexe (Required.)

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5. Position/Poste (Required.)

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6. Name of Institution/Non de l’Institution (Required.)

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7. City/Ville (Required.)

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8. Country/Pays (Required.)

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9. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) (Required.)

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10. Email Address/Adresse email (Required.)

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11. How familiar are you with the contents in this workshop? (Required.)

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12. What are your expectations for this training workshop? (Required.)

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13. How will you fund your participation in this workshop? Comment financerez-vous votre participation à cet atelier ? (Required.)

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14. How did you get to know of these workshops? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant) (Required.)

Newspaper Advertisement / Publicité sur les journaux

Direct Email / Courrier électronique direct

AAU Newsletter / Bulletin de l'AUA

Phone Call / Appel téléphonique

AAU Websites: aau.org or blog.aau.org / Sites Web de l'AUA: aau.org ou blog.aau.org

Social Media / Médias sociaux

Bulk SMS / SMS groupés

Word of Mouth / Bouche à oreille

Other (please specify) / Autre (veuillez préciser)

Question Title

* 1. Title/Titre (Required.)

Question Title

* 2. Surname/Nom (Required.)

Question Title

* 3. Other Names/Prénoms (Required.)

Question Title

* 4. Gender/Sexe (Required.)

Question Title

* 5. Position/Poste (Required.)

Question Title

* 6. Name of Institution/Non de l’Institution (Required.)

Question Title

* 7. City/Ville (Required.)

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* 8. Country/Pays (Required.)

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* 9. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) (Required.)

Question Title

* 10. Email Address/Adresse email (Required.)

Question Title

* 11. How familiar are you with the contents in this workshop? (Required.)

Question Title

* 12. What are your expectations for this training workshop? (Required.)

Question Title

* 13. How will you fund your participation in this workshop? Comment financerez-vous votre participation à cet atelier ? (Required.)

Question Title

* 14. How did you get to know of these workshops? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant) (Required.)

1. Title/Titre (Required.)

2. Surname/Nom (Required.)

3. Other Names/Prénoms (Required.)

4. Gender/Sexe (Required.)

5. Position/Poste (Required.)

6. Name of Institution/Non de l’Institution (Required.)

7. City/Ville (Required.)

8. Country/Pays (Required.)

9. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) (Required.)

10. Email Address/Adresse email (Required.)

11. How familiar are you with the contents in this workshop? (Required.)

12. What are your expectations for this training workshop? (Required.)

13. How will you fund your participation in this workshop? Comment financerez-vous votre participation à cet atelier ? (Required.)

14. How did you get to know of these workshops? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant) (Required.)