AHILA 2019 Registration Form

Title *

Please Select

Name *

First

Last

Other names

Profession

Cadre/Position

Country

Institution

Department

Preferred Mailing Address

City

State/Province

Email *

Post Code

Phone Number(s) *

+234 80X XXX XXXX

Are You presenting a Paper? *

Answer {Yes or No}

Provisional Title of Your paper

e.g {Securing Digital Identities for Healthcare Access}

Are You interested in exhibiting at the Conference? *

Answers: {Yes, No or Maybe}

Do you need transportation from the airport to your hotel? *

Answer{ Yes or No}