REVIVE Investigators Meeting, Zimbabwe

REVIVE Investigators Meeting, December 2024

Victoria Falls, Zimbabwe
Please complete this form and click Submit.
* indicates a required field

Full Name - Enter your name as shown on your valid passport.

Passport Details
Please complete your passport information. It is mandatory you have the correct and necessary travel documents for entry into Zimbabwe. If visa required, please contact us for review.
Title
First Name*
Middle Name
Surname 1*
Surname 2
Birth Date

MonthDayYear
Gender
Country of Issue
Passport #
Date of Issue

MonthDayYear
Date of Expiry

MonthDayYear
Name Badge
Name as preferred on Badge
Institution*
Study Position Title*
Contact information
Mobile Phone*
Business Phone*
Extension
Your Email*
Those with University of Cape Town email addresses should provide personal email addresses only, due to the fire wall issues.
Travel Information
Transportation*
Airport of Departure*
Preferred Airline
Frequent Flyer#
Arrival Date*
Preferred Arrival Time
Departure Date*
Preferred Departure Time
Preferred Seating
Accommodations
Do you require Hotel Accomodation?*
Accommodation will be provided at Elephant Hills Resort for the nights of December 6th, 7th & 8th, 2024. (Extra nights are avilable at your own expense).

If you wish additional nights, please contact meetings@heminggroup.com
Will you be attending the Welcome Dinner on December 6th, 2024?*

YesNo
Will you be attending the Boma Dinner on December 7th, 2024?*

YesNo
Will you be attending the Off Site Dinner on December 8th, 2024?*

YesNo
Dietary Restrictions or Allergies
Additional Information
Should be Empty:

REVIVE Investigators Meeting, December 2024

Accommodations