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Workplace Immersion 2026 Registration form - ED2-1

Full Name:

*

Phone Number

*

Email

*

Age

*

Gender

*

Female

Male

Do you have a laptop?

*

Residence

*

Level of education

*

University/Institute

*

Course/Field of study

*

Year of study

*

Employment status

*

A

Full time job

B

In School/university

C

Self employed/business

D

Freelancer/gig worker

E

Unemployed

F

Others

G

Volunteering

H

Part time job

Are you in any of the era92 elevate programs?

*

Have you participated in any era92 trainings or workshops?

*

What do you hope to achieve from this 3-day program?

*

How did you know about this workshop?

*

Recommend something that would make your attendance worthwhile?

*

Signature

*

Signature