Application Form Please fill this form and return it with a motivation letter (not more than one page) for wanting to participate before the closing date. I would like to apply to attend the training course on “Ethical Issues in Health Research in Africa” from 17 to 20 March 2008. Deadline for receipt of applications: 7 March 2008 1. PERSONAL DETAILS Title Prof./Dr./Mrs./Ms./Mr. (Delete the inapplicable) Surname First Names Profession Highest Qualification Institution Department Mailing Address Phone Fax Cell phone E-mail 2. SPONSORSHIP DETAILS: (Delete the inapplicable) Do you have sponsorship? YES/NO If Yes: State the name of the Sponsor If No: Are you sponsoring yourself? YES/NO If No: Are you looking for sponsorship? YES/NO Are you a recipient of the BRTI-ICOHRTA Fellowship: YES/NO 3. CONTACT DETAILS: BRTI Offices: Tel: +263-4-735000; +263-4-735002 Fax: +263-4-735033