Email address
A valid email address. All emails from the system will be sent to this address. The email address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by email.
Username
Several special characters are allowed, including space, period (.), hyphen (-), apostrophe ('), underscore (_), and the @ sign.
Password
Confirm password
Provide a password for the new account in both fields.
Nom Complet
Genre
Feminin
Masculin
Tranche d'âge
18 à 35 ans
36 à 50 ans
Plus de 50 ans
Webform access
Résidence
- None -
Boucle du mouhoun
Cascades
Centre
Centre est
Centre nord
Centre ouest
Centre sud
Est
Hauts-Bassins
Nord
Plateau central
Sahel
Sud ouest
Exterieur
Catégorie sociaux professionnel
- Select a value -
Agriculteur
Aides familiales
Autre inactif
Chômeur
Elève
Etudiant
Indépendant/employeur
Ménagère
Retraité
Salarié du privé formel
Salarié du public
Salarié du secteur informel
Picture
Your virtual face or picture.
One file only.
300 MB limit.
Allowed types: png gif jpg jpeg.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Math question
5 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
