EDTECH WORKSHOP Registration Form Question Title * 1. Title/Titre Mr Miss/Mlle Mrs/Mme Dr Prof Question Title * 2. Surname/Nom Question Title * 3. Other Names/Prénoms Question Title * 4. Gender/Sexe Male/Masculin Female/Féminin Other (please specify) Question Title * 5. Position/Poste Question Title * 6. Name of Institution/Non de l’Institution Question Title * 7. City/Ville Question Title * 8. Country/Pays Algeria Angola Benin Botswana Burkina Faso Burundi Cabo Verde Cameroon Central African Republic (CAR) Chad Comoros Democratic Republic of the Congo Republic of the Congo Cote d'Ivoire Djibouti Egypt Equatorial Guinea Eritrea Eswatini (formerly Swaziland) Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Libya Madagascar Malawi Mali Mauritania Mauritius Morocco Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone Somalia South Africa South Sudan Sudan Swaziland (renamed to Eswatini) Tanzania Togo Tunisia Uganda Zambia Zimbabwe Other (please specify) Question Title * 9. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) Question Title * 10. Email Address/Adresse email Question Title * 11. How familiar are you with the contents in this workshop? Extremely familiar Very familiar Somewhat familiar Not so familiar Not at all familiar Question Title * 12. What are your expectations for this training workshop? Question Title * 13. How will you fund your participation in this workshop? Comment financerez-vous votre participation à cet atelier ? I will fund myself/ Je prendrai en charge les frais My employer will fund me/Mon employeur prendra en charge les frais I have a donor to assist me/ J'ai un donnateur Other (please specify) 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) 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) Done | Cest Fini