Registration Form
Please carefully read through the instructions for each section of this questionnaire and respond to each item as appropriate . We estimate that it will take no more than 10 minutes to complete this questionnaire.

By completing this form, you consent to participating in the research activities that are associated with this project. Ethics approval has been obtained from the Human Research Ethics Committee, Abia State Ministry of Health.

Email address *
1. What is your surname? *
Your answer
2. What is your first name? *
Your answer
3. What is your sex? *
4. How old are you (years) *
Your answer
5. Which of these best describes your primary practice? *
6. Phone Number *
Your answer
7. Please select your state of residence *
8. Please select your LGA of residence (for Abia State residents only)
9. The workshop component of this course will be held in three locations. Please indicate your preferred location. *
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