Registration Form

+ Select title. Title: * - Select - Mr.Mrs.MissMs.Dr.Sr.Prof. Other
+ Surname is required. + First names required.
+ Preferred name is required. Preferred Name (For Name Tag): *
+ Email is required. + Specify a valid e-mail address. E-mail: *
+ Select if you are a NHLS employee. + Employee number is required.
+ Select if you are HPCSA registered. + HPCSA number is required.
+ At least one contact number is required.
+ Contact in case of emergency is required. + Emergency contact number is required.
+ Institute is required. + Other is required.
+ Department/Research Unit is required. Department or Research Unit: *
+ Discipline is required. + Other is required.
+ Address Line 1 is required. Address Line 1: *
Address Line 2:
+ City is required.
+ Postal/Zip code is required. Postal/Zip code: *
+ Country is required. Country: * South AfricaUnited StatesUnited KingdomAlgeriaAngolaAustraliaBeniBotswanaBurkina FasoBurundiCameroonCape VerdeChadComorosDemocratic Republic of the CongoDjiboutiEgyptEquitorial GuineaEritreaEthiopiaGabonGhanaGuineaGuinea-BissauIvory CoastKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritianaMauritiusMozambiqueMoroccoNamibiaNew ZealandNigerNigeriaRepublic of the CongoRwandaSao Tome and PricipeSenegalSeychellesSierra LeonneSomaliaSouth SudanSudanSwazilandTanzaniaThe GambiaTogoTunisiaUgandaZambiaZanzibarZimbabwe Other
+ Delegate status is required. + Other is required.
+ Dietary request is required. + Other is required.
+ Preferred Session Day 1 is required. Preferred Session Day 1: * - Select - Building Sustainable Research CapacityEnabling Research Infrastructure
+ Preferred Session Day 2 is required. Preferred Session Day 2: * - Select - Positioning and profiling research within the NHLSResearch Support: Funding and Forging partnerships
+ Require Hotel Accomodation is required. + Arrival Date is required.
+ Require shuttle is required. + Arrival time is required.