Registration form 
 
Name
		
Surname 
		
Country 
		
Organisation
		
E-mail
		
Phone number (please, include country code) 
		
Skype address 
		
Education (degree and subject) 
		
Preferred language of the course (the course is available in English and Russian)  
		
Experience in harm reduction (if you have any experience in harm reduction, please describe) 
		
Motivation to take part in the course (please, state why you are interested taking part in this course and how you are going to use knowledge and skills obtained)  
		
Expectation from the course (please, state your expectations both for theoretical and practical parts of the course) 
		
Preferred dates for the 1 module (5 days) 
		
Please, state if you require a partial/full scholarship

•	Please send your form to this e-mail: tshub@aidsalliance.org.ua
•	Number of scholarships is limited