iphu a2m refresher/add-on Please enable JavaScript in your browser to complete this form.Personal InformationFirst Name *Last Name *Gender *MaleFemaleOtherDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Country *Contact InformationEmail *Alternate EmailPhonePrevious Course AttendedPHM and TWN have organised three IPHU courses on 'The Struggle for Health and Access to Affordable Medicines'. Which one did you attend? *1) Savar, Bangladesh-20182) CapeTown, South Africa-20193) Middle East and North Africa, Online Course-2020Why could the course on Access to Covid-19 medical products be important for you and your activism (Paragraph Text)Professional InformationEducation *Occupation *Institution *Language SkillsEnglish *ExcellentGoodFairPoorAny other language (please type in box)ExcellentGoodFairPoorOnline Course RequirementsDo you have access to a reliable computer/laptop *YesNoDo you have access to a reliable internet connection *YesNoDo you agree to commit atleast 6 hours every week towards the course and course work *YesNoThere will be one class per week ( 3 hours). Which is the day of your preference for the class- Wednesday or Saturday? *Wednesday (at 11:30 hrs GMT)Saturday (at 8:30 hrs GMT)Either of the days(Kindly note that the organisers will take the final decision between Wednesday and Saturday)CommentSubmit
