Registration

Conference registration with the payment of registration dues.

(Kindly note that while registration can be done online at any time before the conference payment will only be made at the venue)

Full name as appears in you passport (Surname first) *

Gender *

Male

Female

Date of Birth *

Nationality *

Country of Residence *

Email Address *

WhatsApp/Phone Number *

Region in Africa

Central Africa

East Africa

North Africa

West Africa

Southern Africa

Specialisation (E.g. Surgery, Anaesthesia, ENT, Speech Therapist, Nurse, Social Worker, etc) *

Center/Institution/Organization *

Center/Institution/Organization Address *

Job Title *

Are you presenting an abstract during this conference? *

Yes

No

Dietary Requirements (Please specify any dietary restrictions or preferences)

Special Accommodation: (Please specify any special accommodation you may need)

Declaration: By submitting this form, I declare that the information provided is true and accurate to the best of my knowledge. I understand that providing false information may disqualify me from attending conference. (TYPE YOUR FULL NAME) *

Date *

Registration

CONTACT