Innovation in Contraceptive Research Workshop - Registration Form
Date: September 3 - 5th, 2024 (previously May 21st - 23rd, 2024)
Address: Sarova Whitesands Beach Resort (Off Malindi Road, Mombasa County, Mombasa, Kenya)
Contact us at crw@evms.edu
Please provide your first and surname: *
Age: *
Which of the following terms best fits your gender identity right now? Please check all that apply. *
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Country of residence? *
Institution or organization affiliation: *
Preferred email: *
Phone number: *
Will you be attending: *
Please specify which sessions you are interested in attending (below).  Choose one training from each day. *
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Highest level of education obtained: *
Emergency contact name and phone number: *
Will you be submitting an abstract for the Poster Presentation? *Selected abstracts will qualify for travel assistance. *
For poster abstracts, please select a track below: *
How did you hear about this workshop? *
If you require special accommodations, please specify below:
Please select any dietary restrictions from the options below: *
If you have any food allergies and dietary restrictions not indicated above, please specify below:
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