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Registration Form - AIBBC 2019

Please fill in blanks and click confirmation.
* indicates required field.

Title*
Last name*
First Name*
Middle Name
E-mail Address*
E-mail Address(Confirmation)*
Affiliation - Institution*
Affiliation - Department*
Position (choose your position)*
Country (select country)*
Physical address*
AIBBC MEMBERSHIP (Select one)*
Abstract Submission*

If yes, enter abstract title*
Attendance (Select one from below)*
Expected date of arrival*
Will you require accommodation In Nairobi *

Will you require accommodation In Mombasa*

Do you have accompanying persons

If YES, How many
Will you need accommodation for accompanying persons
Dietary restrictions/Special requests (We will try to meet your request but not guaranteed)
If Others, specify
Fee Category *







SELECT*

Expected date of transfer(yyyy/mm/dd)*