SIGN UP FORM FOR THE THAL e-COURSE

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By completing this form you declare interest to take the TIF Thal e-Course. More information about the course is available at https://thalassaemia.org.cy/platform-patients/

Name *

Surname *

E-mail Address *

Date of Birth *

Gender *

Female

Male

Country *

Medical Condition *

β - Thalassaemia major

Thalassaemia Intermedia / Non-Transfusion Dependent Thalassaemia

Sickle Cell Disease

Parent of β-Thalassaemia major

Parent of NTDT patient

Tell us why you want to take this course *

Please name the patient organisation that you belong to: *

The course is available in several languages. Please choose the language of your preference: *

English

Arabic

French

Italian

German

Greek

Level of chosen language based on Common European Framework of Reference of Languages *

A1 Beginner

A2 Elementary

B1 Intermediate

B2 Upper Intermediate

C1 Advanced

C2 Proficient

Thank you for your subscription

A selection process will follow. You will be notified about the outcome shortly to the email address you have provided above. If you have any questions please contact TIF Academy at academy@thalassaemia.org.cy or thalassaemia-kp@thalassaemia.org.cy The personal information provided in this form will be kept by TIF for the maximum period of 6 months on TIF's cloud provider.

Disclaimer

Any personal data provided in this form will not be disclosed to third party without your written consent.

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