Title *
- Select - Prof Dr Mr Mis Mrs
First Name *
Last Name *
Sex *
- Select - Male Female
Affiliation Full Members (Leaders at INDEPTH Member Centres only)
- None - AHRI, South Africa Arba Minch , Ethiopia Agincourt, South Africa Ballabgarh, India Bandafassi, Senegal Bandarban, Bangladesh Bandim, Guinea-Bissau Birbhum, India Butajira, Ethiopia Chakaria, Bangladesh Chililab, Vietnam Chókwè,Mozambique Cross River , Nigeria Dabat, Ethiopia Dikgale, South Africa Dodalab, Vietnam Dodowa, Ghana Farafenni, Gambia Filabavi, Vietnam Gigel Gibe, Ethiopia Ifakara, Tanzania Iganga/Mayuge, Uganda Kanchanaburi, Thailand Karonga, Malawi Kaya, Burkina Faso Kersa, Ethiopia Kilifi, Kenya Kilite Awlaelo, Ethiopia Kintampo, Ghana Kisumu, Kenya Kombewa, Kenya Kyamulibwa, Uganda Magu, Tanzania Manhica, Mozambique> Matlab, Bangladesh Mbita, Kenya Mlomp, Senegal Nahuche, Nigeria Nairobi, Kenya Nanoro, Burkina Faso Navrongo, Ghana Niakhar, Senegal Nouna, Burkina Faso Ouagadougou, Burkina Faso PiH, Papua New-Guinea Purworejo, Indonesia .Rakai, Uganda Rufiji, Tanzania Sapone, Burkina Faso Taabo, Côte d'Ivoire Vadu, India West Kiang, Kenya
Affiliation Associate Members (Leaders or Reps at Associate Member Centres
- None - Kanchanaburi HDSS Thailand Magu HDSS Tanzania West Kiang HDSS The Gambia Wosera HDSS Papua New Guinea Ifakara HDSS Tanzania Rufiji HDSS Tanzania Oubritenga DSS Burkina Faso AMK Bangladesh Mekong Cambodia Tanzania Dar es Salaam DSS Tanzania Hai DSS Tanzania Tanzania Morogoro DSS Tanzania Zambia Gwembe DSS Zambia Urumqi China Caxi Angola Karachi Pakistan Leon Nicaragua Uganda Keur Soce Senegal Korogwe Tanzania Muzaffarpur India Oriade Nigeria SEACO Malaysia Bukavu DR Congo Bioko Island Equitorial Guinea
Affiliation (for people not affiliated to INDEPTH site)
Country travelling from
- None - Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Nationality *
- Select - Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Position *
Street and House No.
P. O. Box
City
Telephone *
Email *
Would you like to be lodged at the Conference hotel? :
- None - Yes No, but I need help to get a nearby hotel No, I will make my own arrangements
Would you need assistance for visa to Duabai, UAE *
- Select - Yes No
For self-funded participants:
- None - I need airport pick-up at my own cost I do not need airport pick-up
Other Names