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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
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Please provide your first and surname:
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Your answer
Age:
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18-30
31-40
41-50
51-60
61-70
71-80
> 80
Which of the following terms best fits your gender identity right now? Please check all that apply.
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Woman, including transgender woman, trans feminine
Man, including transgender man, trans masculine
Another gender
I am not sure or questioning
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Country of residence?
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Your answer
Institution or organization affiliation:
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Your answer
Preferred email:
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Your answer
Phone number:
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Your answer
Will you be attending:
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In-person (Morning and Afternoon sessions)
Virtual (Morning sessions ONLY)
Please specify which sessions you are interested in attending (below). Choose one training from each day.
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DAY 1 - Social and behavioral research and human-centered design (Afternoon session)
DAY 1 - Mucosal samples for multiple Phase I endpoints (Afternoon session)
DAY 2 - Sperm functional AND cervicovaginal cytotoxicity assays (Afternoon session)
DAY 2 - Phase I clinical trials for multi-purpose technologies (Afternoon session)
Required
Highest level of education obtained:
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Bachelors degree
Masters degree
Doctorate
Post-doctorate
Emergency contact name and phone number:
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Your answer
Will you be submitting an abstract for the Poster Presentation? *Selected abstracts will qualify for travel assistance.
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Yes
No
For poster abstracts, please select a track below:
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A - Basic science research
B - Clinical research
C - Sociobehavioral research
Not applicable
How did you hear about this workshop?
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Colleague or friend
Social Media
Employment or academic institution
If you require special accommodations, please specify below:
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Please select any dietary restrictions from the options below:
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Vegetarian
Vegan
Halal
Kosher
Gluten-free
Dairy-free
None
If you have any food allergies and dietary restrictions not indicated above, please specify below:
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