Page 1 of 1

RAPN Conference Registration Form

Please enter your details below, select a Registration type (Physical Attendance or Virtual Attendance) and Make payment, to register for the African Regulatory, Quality & Safety Conference

Personal Details:

First Name:

*

Last Name:

*

Title:

*

Institution:

*

Email:

*

Phone:

*

Registration Type (50% OFF):

*

Additional Information:

Dietary Restrictions:

Special Requests:

Declaration

I hereby declare that the information provided is accurate and true. I understand that registration fees are non-refundable.

Signature

*

Sign in the area above

Date

*

Total Amount =