Application form

From HarambeeWiki

“A Stop On The Harambee Safari: Achievements, Challenges, Learnings And Opportunities”

Workshop Application Form

Please fill in the following questions. All questions are mandatory.

I. Applicant Information First name: ______________________
Last name:________________________
Gender: ______________________
Name of Organization/network: ______________________________
Designation:________________________________________________

II. Address P. O. Box: ____________________________________
Telephone Number: _____________________________
Fax Number: ___________________________________
Email: ________________________________________
Organization website: _________________________

III. Interest in participation 1. Give us a brief description about work done by your organization/network

  _________________________________________________________________________
  _________________________________________________________________________
  _________________________________________________________________________
  _________________________________________________________________________

2. What would you like to take away from this workshop?

  _________________________________________________________________________
  _________________________________________________________________________
  _________________________________________________________________________
  _________________________________________________________________________

3. In what ways do you feel you can contribute to this workshop?

  _________________________________________________________________________
  _________________________________________________________________________
  _________________________________________________________________________
  _________________________________________________________________________

IV. Logistical information

1. What costs would you need covered in order to participate. Please indicate ‘Yes’ or ‘No’ as appropriate.

  a. Travel_______

  b. Accommodation_______

  c. Both______

2. Which country will you be traveling from? __________________________
3. Do you require a visa to travel to Uganda?_________________________