*1.Prénom/First Name(Required.)

*2.Nom/Last Name(Required.)

*3.Adresse email/Email address(Required.)

*4.Sexe/Sex(Required.)

Masculin/Male

Féminin/Female

Préfère ne pas répondre/Prefer not to say

*5.Institution/Organization(Required.)

*6.Occupation(Required.)

*7.Niveau d'éducation le plus élevé/Highest Level of Education(Required.)

Diplome/Diploma

Licence/Bachelor's degree

Master/Master's degree

Doctorat/PhD

Autre (Préciser)/Other (please specify)

*8.Dans quel pays vivez-vous?/In what country do you live?(Required.)

AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDemocratic People's Republic of KoreaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia (Federated States of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth ‎SudanSpainSri LankaState of PalestineSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandThe former Yugoslav Republic of MacedoniaTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and CaicosTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited Republic of TanzaniaUnited States of AmericaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)VietnamYemenZambiaZimbabwe

*9.Je souhaite recevoir de futures communications sur les événements/opportunités/I would like to receive future communication on events/opportunities(Required.)

Yes

No