Pre-registration Form Choose the course you wish to submit your pre-registration for*Module I: Key Disciplines in Poultry Health/Regulation Module OIE-WOAH, January – April, 01 February – 28 June 2021Módulo I: Disciplinas comunes y aspectos reglamentarios de la OIE – WOAH, 01 abril – 30 julio 2021Module II: Egg layers, 01 June -29 October 2021Módulo II: Producción de pollo de engorde y enfermedades, 01 octubre 2021 -28 febrero 2022Personal informationTitle* Mr. Mrs. Ms. Name* First Last Email* Enter Email Confirm Email Organisation* Date of birth* Day Month Year Country of birth* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*EducationUniversity* Name of the University Country Degree* Degree Year obtained Reason for your interest in the WVEPAH coursesMailing from WVEPAHOther Internet pagesAdvertisement in Vet journalsColleague recommandationInformation at congressOtherConsent* Consent to data processingProcessing of personal data If you send in any enquires via the contact form, we store the information you submit in the enquiry form, including the contact data you indicate there, to process your query as well as for follow-up questions. Please note in order to be able to answer your enquires or comply to your request we may link the information from your e-mails or contact forms to your personal data in our system. Processing, use and disclosure of personal data a) Internal use: Personal data supplied by you is used for processing and fulfilment of the contract as well as for technical administration, marketing and statistical evaluation. b) Disclosure of personal data: Personal data will only be transmitted or otherwise transferred to third parties as is necessary for the purpose of fulfilling the contract, for operational and security reasons, for accounting purposes or if you have given prior consent. c) Further disclosure: Other than that, data is only disclosed in compliance with the legal data protection regulations or upon request by government agencies, courts and fiscal authorities or in connection with claims asserted by a third party because of a possible violation of proprietary rights (copyrights, trademark rights and other ancillary copyrights) by a proprietor. Deletion of stored data, information, blocking and revocation Please note the WVEPAH is a continuing professional education institution supporting and facilitating the ongoing pursuit of knowledge in veterinary medicine. The aim and purpose of the WVEPAH activities comprise ongoing efforts to encourage its customers and vendors (participants, course masters, speakers, sponsors and other co-operation partners) to ongoing professional development and further education. We store all personal data submitted by you only as long as needed to fulfil the purposes for which you have given us the data or as long as prescribed by law. Those responsible for data protection are the WVEPAH employees who process your data. Your contact for questions regarding the collection, processing or use of personal data, as well as for information on the correction, blocking or deletion of data is email@example.comSignature*I consent to provide personal data to the WVEPAHPhoneThis field is for validation purposes and should be left unchanged.