PATA 2020 Summit
Participant Registration Survey

Breakthrough and Build Back together

Reaching goals and rebuilding on the frontlines of paediatric and adolescent HIV service delivery during COVID
11 – 13 November 2020

TeamPATA would like to invite and welcome you to the PATA 2020 Summit, titled Breakthrough and Build Back together!

Online registration for the summit will be open between 13 October – 08 November; for those attending main or satellite spokes, you can also register on the first day of the summit at the designated registration table. However, we would encourage participants to register before the start of the summit.

Once registered you will be sent a link to the PATA 2020 Summit landing page with a code to sign into and enter the virtual hub where you can access all online sessions.

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* 1. Name

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* 2. Surname

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* 3. Gender

Male

Female

Non-conforming

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* 4. Date of birth

Date

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* 5. Email address

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* 6. Contact Numbers

Cellular phone:

Work:

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* 7. Country of residence

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* 8. City

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* 9. Have you attended a PATA Summit before?

No, this is my first PATA Summit

I have attended one PATA Summit in the past

I have attended more than one PATA Summit in the past

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* 10. My primary reason for registering for the PATA Summit is to

Learn something new about taking care of children and adolescents living with HIV (C/ALHIV)

Learn what challenges C/ALHIV are facing

Learn what the challenges are facing healthcare workers providing services to C/ALHIV

Improve the way I do my job

Teach or share what I have learned with the PAT network about caring for C/ALHIV

Learn more about PATA

Meet or connect with others who have similar experiences to my own

Other (please specify)

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* 11. Name of health facility or organisation

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* 12. My primary job responsibility is

Providing services directly to patients/clients

Providing services directly to my peers

Supervising or teaching healthcare workers

Managing/supporting a national government programme

Managing/supporting a non-government programme or project

Advocacy

Supporting or making funding decisions

Research

Other (please specify)

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* 13. Position or role at health facility or organisation

Health provider

Peer Supporter

Community Health Worker

Counsellor

Community-based implementing partner

Lead organisation (National/Regional NGO)

National Ministry of Health

International partner organisation/donor

UN agency

Other (please specify)

PATA 2020 Summit Participant Registration Survey

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* 1. Name

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* 2. Surname

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* 3. Gender

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* 4. Date of birth

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* 5. Email address

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* 6. Contact Numbers

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* 7. Country of residence

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* 8. City

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* 9. Have you attended a PATA Summit before?

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* 10. My primary reason for registering for the PATA Summit is to

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* 11. Name of health facility or organisation

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* 12. My primary job responsibility is

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* 13. Position or role at health facility or organisation

PATA 2020 Summit
Participant Registration Survey