Formulario de Inscripción

Strategic Response to Risk in Microfinance Markets
Washington DC, USA (November 27 - December 1, 2017)

Please read the form below carefully and provide the requested information (*)


Concentration you would like to attend: *
Which languages do you speak fluently? *
What is your level of fluency in English? *
Title *
First name / Given name *
Family name(s) / Surname *
Gender *
Work Information
Institution you work for *
Type of institution *
Institutional web site
Job Title *
Job Type *
Level of responsibility *
Duty station/Work address *
City *
Country *
Phone: (country code) (city code) (phone number) *
Cell Phone: (country code) (city code) (phone number)
Skype username
E-mail *
Second E-mail address
Assistant name
Assistant email
Food Preferences *
Please upload your picture in jpg format (max.size 50K)


Do you need a visa to attend the Program? *
Full name as written on passport (should include name, middle and last names)
Nationality *
PASSPORT N.
Place of issue
Date of Issue (DD-MM-YYYY)
Date of Expiry (DD-MM-YYYY)
Place of Birth *
Date of birth (DD-MM-YYYY) *
Embassy/consulate where you applying for the visa
Embassy/consulate address
Passport and Visa Comments

This information only refers to your sponsor organization.
TUITION SPONSOR
Type of sponsor *
Name of tuition sponsor *
Contact person *
Sponsor contact's email *
Sponsor contact job title *
Address *
City *
ZIP code
Country *
Phone: (country code) (city code) (phone number) /extension *
If you already have it, please upload the tuition proof of payment in jpg or pdf format (max.size 100K)
ACCOMMODATION
In which hotel will you be staying?
If other hotel than those listed on our website please tell us


How many years of overall experience do you have in microfinance or financial inclusion? *
Are you engaged in financial inclusion as a funder/donor, project implementing agency, financial institution or other? Please explain what you do. *
How would you rate your knowledge of microfinance? *
Please describe a financial inclusion program you are currently working on? In what country? How many clients is it serving? *
Would you like to share one challenge you are facing in this sector?
What 3 areas of financial inclusion would you primarily like to explore at the Strategic Risk Response Program in response to the challenges above or personal preference? *
How did you learn about the Boulder’s Strategic Risk Response Program? *


Country and city of Departure *
Arrival Airport
Arrival date (DD-MM-YYYY) *
Arrival Time (00:00-23:59)
Arrival Flight Nr. and airport
Departure date (DD-MM-YYYY) *
Departure Time (00:00-23:59)
Dep. Airport and Flight
Travel comment

After clicking 'Send Registration' below, you will receive confirmation that you are registered for this year’s 2017 Back to Boulder program. Please do the following math as a security code:

	Photography consent form * Your registration constitutes permission to Boulder Institute of Microfinance employees, agents and representatives to use and publish photographs, digital images, videotape, audio recording, and / or quoted remarks taken of you, your presentations and surrounding belongings during the 2017 B2B program for use in electronic publications, websites, blogs, interactive media or other electronic communications for the sole purpose of educational and marketing efforts. In addition, your name and identity may be revealed in descriptive text or commentary in connection with the aforementioned images and/or quotes taken during the program. If you do not wish to be interviewed or photographed during our program, please let our staff know, and you are entitled to refrain from participating during these moments.
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