Participant Details

Family Name   ………………………………………………………..
Fist Name         ………………………………………………………..
Position            …………………………………………………………
Organisation   ……………………………………………………….
Country of Residence    …………………………………………
Cell phone number       …………………………………………..
Landline       …………………………………………………………….
Email     ……………………………………………………………………

Registration Details

Title  of  Course    …………………………………………………………………………………………..
Start Date of course    …………………………………………………………………………………….
End Date of course      …………………………………………………………………………………….
Number of sessions     …………………………………………………………………………………….
Cost of Course per person     …………………………………………………………………………..
Number of people attending   ………………………………………………………………
Total cost  due                                           ………………………………………………
Payment method                                    Paypal       [email protected] 
Date of payment sent                        …………………………………………………………
Please note that payment must be completed one week before the start of the course
Once payment has been received your Zoom invitation will be sent to join the meeting
Please send the completed form to Dr. Juliet Waterkeyn     email [email protected]

Thank you for registering with Africa AHEAD Association

We look forward to your participation