Registration Form

Question Title

* 1. Title/Titre

Question Title

* 2. Surname/Nom

Question Title

* 3. Other Names/Prénoms

Question Title

* 4. Gender/Sexe

Question Title

* 5. State your discipline/Specialist area 

Question Title

* 6. Position/Poste

Question Title

* 7. Name of Institution/Non de l’Institution

Question Title

* 8. Is your institution an AAU member?

Question Title

* 9. Address/Adresse

Question Title

* 10. City/Ville

Question Title

* 11. Country/Pays

Question Title

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

Question Title

* 13. Email Address/Adresse email

Question Title

* 14. What would you want to be emphasised for your benefit during this workshop?

Question Title

* 15. What else would you want to be learn about besides the content that is being covered?

Question Title

* 16. How did you get to know of the pilot workshop? (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)

THANK YOU | MERCI

T