Username*

Email

Password*

Password again*

First name*

Last name*

Job title

Organisation

Phone number

Work Area

Region

Region (other)

Region UID

Sub-City

if region is Addis Ababa

Woreda

Woreda UID

Profession

Please specify

Primary place of work

Name of health facility or organization

Facility ID

Gender

Referred from

How did you hear about the COVID-19 Ethiopia app?

Other (please specify)

Who did you hear about the COVID-19 Ethiopia app from?

Other (please specify)