SIGN UP FORM FOR THE THAL e-COURSE
By completing this form you declare interest to take the TIF Thal e-Course. More information about the course is available at
https://thalassaemia.org.cy/platform-patients/
* Required
Name
*
Your answer
Surname
*
Your answer
E-mail Address
*
Your answer
Age
*
Your answer
Gender
*
Female
Male
Country
*
Your answer
Medical Condition
*
β - Thalassaemia major
Thalassaemia Intermedia / Non-Transfusion Dependent Thalassaemia
Sickle Cell Disease
Parent of β-Thalassaemia major
Parent of NTDT patient
Tell us why you want to take this course
*
Your answer
Please name the patient organisation that you belong to:
*
Your answer
The course is available in several languages. Please choose the language of your preference:
*
English
Arabic
French
Italian
German
Greek
Level of chosen language based on Common European Framework of Reference of Languages
*
A1 Beginner
A2 Elementary
B1 Intermediate
B2 Upper Intermediate
C1 Advanced
C2 Proficient
Thank you for your subscription
A selection process will follow. You will be notified about the outcome shortly to the email address you have provided above. If you have any questions please contact TIF Academy at
academy@thalassaemia.org.cy
or
thalassaemia-kp@thalassaemia.org.cy
The personal information provided in this form will be kept by TIF for the maximum period of 6 months on TIF's cloud provider.
Disclaimer
Any personal data provided in this form will not be disclosed to third party without your written consent.
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