This Form Details will be sent to the Trainer Secretariat Name * First Name Last Name Email * Phone * Country (###) ### #### Year of Birth MM DD YYYY Gender * Male Female Prefer not to Say Country of Residence Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinat.State) Bonaire/S.Eustatius/Saba Bosnia and Herzegovina Botswana Brazil British Indian Ocean Ter British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Channel Islands Chile China China, Hong Kong SAR China, Macao SAR Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Dem. Rep. Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czechia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Is.(Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea. Korea, Republic of Kuwait Kyrgyzstan Lao People's Dem. Rep. Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia, Fmr Yug Rp Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia,Fed.States Moldova, Republic of Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Northern Mariana Is. Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent/Grenadines Saint-Martin Samoa Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Province of China Tajikistan Tanzania, United Rep. of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Is. Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay US Virgin Islands Uzbekistan Vanuatu Venezuela, Boliv Rep of Viet Nam Wallis and Futuna Is. Western Sahara Yemen Zambia Zimbabwe Course * Confirm Course Being Applied For. Trainer 1101: Research & Project Implementation 1 (USD 30) Trainer 1102: Research & Project Implementation 2 (USD 30) Trainer 1103: Research & Project Implementation 3 (USD 50) Trainer 1201: Research Tools & Software in Biostatistics 01 (USD 35) Trainer 1202: Research Tools & Software in Biostatistics 02 (USD 40) Trainer 1203: Research Tools & Software in Biostatistics 03 (USD 50) Programme * Zoom Classes take place on Saturdays and Sunday at 01:00 Pm GMT+0 (Be sure to convert 01:00Pm GMT+0 in your local time to be able to catch up with the classes. Saturday & Sunday at 01:00 Pm GMT+0 Occupation * Select the field of work you belong to. Health Sciences Medicine Nursing Biomedical Sciences. Agricultural Sciences Veterinary medicine Laboratory sciences. Social Sciences. Pharmacy Dental Surgery. Others Field Applicant Category * 1. Current practicing Professionals in one of the above fields. 2. Recent university Graduates with graduation not more than 8 years ago in the above fields. 3. Master students at least in Year 1 of study and above in the field stated. 4. Medical Intern Doctors, Nurses and Pharmacists with good research track record. 5. Medical Officer, Veterinary Officer, Nursing Officer, Midwife, Pharmacist, Dental Surgeon Others Institution * Name of the organisation you are working with or Institution you are attached to now or University/College you are attending. Have you ever written or taken part in writing a research proposal.. * Yes No Have you ever taken part in data collection? Yes No Have you ever published an article. * Yes No Have you ever Written a manuscript? Yes No Have you ever published a story of Self, us and Now. Yes No Have you ever analysed any data sets using any data analysis tool? * Yes No
