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AFEM OPEN DAY REGISTRATION FORM
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* Indicates required question
Name of Organization/Institution
*
Your answer
Country of registration/head office
*
Your answer
Country(s) of work
Your answer
Contact person
*
Your answer
Email
*
Your answer
Phone
*
Your answer
What is your organization/institution focus:
Pre-hospital based emergency care
Hospital based emergency care
Education
Research
Training
Advocacy
Governance/leadership
Programme National des Urgences/ RDC
Student interest group
medical council board
Other:
How did you find out about the AFEM Open day?
Your answer
What is your interest in joining the open day?
Your answer
What made you decide to participate in the AFEM open day?
Your answer
Do you know any other organizations/institutions that might be interested in joining? If so please share their contact information.
Your answer
We welcome you to join our AFEM family as a member. If you would like to become an AFEM member, kindly click the link below:
https://docs.google.com/forms/d/e/1FAIpQLSfz9L_CIl_Qrb7SdYGx2cvMBuxmAEqvdRq7JsW1RtRhIL4cgQ/viewform
Your answer
If you would like to support AFEM activities through a donation, click here:
https://www.givengain.com/cc/afem-open/
Your answer
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