2019 Online Teaching Academy 16 October – 27 November 2019 Date Date Format: MM slash DD slash YYYY Personal information:Name* Title Mr.Mrs.Ms.Dr.Prof. First Last Job Title*Company/Institution*Address* Street Address City ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo (Congo-Brazzaville)Costa RicaCroatiaCubaCyprusCzechiaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPalestine StatePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweRegretfully, we are not able to process your registration. Please contact firstname.lastname@example.org for further information.Email* Phone*My portraitPlease attach your photo in JPG format (full face portrait; 5MB max.). The photo will be added to the participants list to facilitate networking.Accepted file types: jpg.English Proficiency*(the programme is conducted in English)AdvancedIntermediateElementaryProfessional backgroundProfessional work experience (in years)*Number of years in the current position*How would you describe your prior knowledge and online teaching skills?*Working knowledge & skillsBasic knowledge& skillsNo prior knowledge or skillsMembership:Membership Status*EFMD memberNon-memberFee:as EFMD member Price: 3.200,00 € as non-member Price: 3.500,00 € Coupon Total 0,00 € Payment method*Bank transferCredit CardCredit Card Card Details Cardholder Name Previous attendance:Have you already participated in any event offered by EFMD Professional Development?YesNoPlease indicate which event you attended*Catering:I will join:* Networking dinner on 4th November Networking dinner on 5th November I am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*Dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other', please specify:*General:I agree with the terms and general conditions stated on your website.* Yes I declare that all the information stated above is accurate, including allergies and dietary requirements.* Yes I authorise EFMD & EFMD GN to use all information communicated within the legal framework of its activities.* Yes I agree for my name, picture and professional details to be added to the lists distributed to participants at this event.*Your contact details will never be disclosed to external parties nor used for commercial purposes.YesNoI agree to receive an e-mail newsletter and other communication material from EFMD & EFMD GN.*You can unsubscribe or update your preferences at any time.YesNoTechnical InformationNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.