Download Application

REGISTRATION FORM

Or Download PDF form here


Please check the workshop that you are registering for:

International Executive Media and TV Workshop (IEMTW)

Which workshop are you registering for? (Indicate in the space below)

­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________________

Strategic Communications for Governance   (SCG )

Which workshop are you registering for? (Indicate in the space below)

­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________________

Strategic Media Skills for Senior Managers (SMS)

 

Which workshop are you registering for? (Indicate in the space below)

­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________________

Social Media for Communication Managers (SMCM)

Which workshop are you registering for? (Indicate in the space below)

­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________________

Communication Stratégique : Comment faire face aux médias (CS)

Which workshop are you registering for? (Indicate in the space below)

­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________________

Last Name: ___________________________________________________________
First Name: ___________________________________________________________
Nationality: ___________________________________________________________
Passport #: ___________________________________________________________
Date of Birth: ___________________________________________________________
Place of Birth: ___________________________________________________________
Gender: Male:____   Female:____
Organization: ___________________________________________________________
Present Title: ___________________________________________________________
WORK ADDRESS
Street/P.O. Box: ___________________________________________________________
City, State, Zip: ___________________________________________________________
Country: ___________________________________________________________
Phone: ___________________________________________________________
Fax: ___________________________________________________________
E-Mail: ___________________________________________________________
HOME ADDRESS
Street/P.O. Box: ___________________________________________________________
City, State, Zip: ___________________________________________________________
Country: ___________________________________________________________
Phone: ___________________________________________________________
Fax: ___________________________________________________________
E-Mail: ___________________________________________________________
Education: ___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
English Speaking and Writing Ability:
(please circle)
            Excellent         Very Good         Good         Fair
French Speaking and Writing Ability:
(please circle)
            Excellent         Very Good         Good         Fair
Course Tuition Fees will be paid by:
(please circle)
            Sponsoring        Self
Organization

If sponsored, please return Sponsorship Form.

Tuition includes trainer costs, background and course materials, one hour of individual executive coaching, and all coffee breaks. Fees do not cover airfare. Participants are responsible for their own travel arrangements, costs and any visa arrangements. Fees must be paid in US dollars prior to the start of the workshop. Please see the schedule for payment deadlines.

100% of the tuition will be refunded up to two (2) weeks before the workshop begins. After two weeks, there will be no refund, unless cancellation was necessary due to exceptional circumstances.

Qualified participants who are interested in receiving sponsorship or financial support can consider contacting the following agencies which have sponsored participants or participated in CDC training events: USAID country missions in Amman, Beirut, West Bank, Morocco and Egypt, UNICEF or UNDP offices, UNFPA, International Fund for Agricultural Development, or the European Union. Other specialized agencies such as UNRWA may also send staff or provide sponsorship.

Enrollment at all CDC International Executive Training Workshops is subject to availability and approval by CDC staff. All applications will be reviewed by CDC.

I VERIFY THAT ALL STATEMENTS IN THIS APPLICATION ARE TRUE AND CORRECT.


_____________________________       _________________
Signature                                           Date

Please return the completed form to:

Mr. Moncef M Bouhafa
The Center for Development Communication
PO Box 25228
Washington, DC 20007
USA

Or fax the signed form to: +1 413 702 5694

Social Media

Follow us on Facebook
Follow us on Twitter

Moncef Bouhafa


Program Director
Contact Moncef