AMCOA 2025 Annual Capacity Building Workshop Registration Form (International Delegates)
Please book for your spot at the AMCOA Annual Capacity Building Workshop by filling the form below.
Personal Details
Title
Please Select
Mr.
Mrs.
Ms.
Adv.
Dr.
Prof.
Full Name
*
First Name
Last Name
Preferred Name for Badge
*
First Name
Last Name
Industry
Academia
Administrators
Finance and Professional Services
Government
Healthcare services & providers,
Media
Health insurance and health management organisations (HMO)
NGO
Pharmaceuticals
Regulatory Authority
Technology and Innovation
Other
Other
Please provide details of other
First Time Attendee
Yes
No
Member Affiliation
*
AMCOA Member
AMCOA Associate Member
Other
Other
Please provide details of other
AMCOA Member
Please Select
Botswana Health Professions Council
Burundi Medical Council
Burkina Faso Medical Council
Eswatini Medical and Dental Council
Medical and Dental Council Gambia
Medical & Dental Council of Ghana
Kenya Medical Practitioners and Dentists Council
Medical, Dental and Pharmacy Council Lesotho
Liberia Medical and Dental Council
Medical Council of Malawi
Dental Council of Mauritius
Medical & Dental Council of Nigeria
Health Professions Councils of Namibia
Rwanda Medical and Dental Council
Seychelles Medical & Dental Council
Medical & Dental Council of Sierra Leone
National Health Professionals Council Somalia
Health Professions Council of South Africa
South Sudan General Medical Council
Sudan Council
Medical Council of Tanganyika (Tanzania)
Medical and Dental Practitioners Council of Uganda
Health Professions Council of Zambia
Medical and Dental Practitioners Council of Zimbabwe
AMCOA Associate Member
Please Select
American Osteopathic Association
Ethiopian Medical Association
Allied Health Professions Council of Rwanda
Education Commission for Foreign Medical Graduates
Uganda Allied Health Professions Council
Health Professions Authority of Zimbabwe
Kenya Health Professionals Oversight Authority
Allied Health Professions Council Zimbabwe
The World Continuing Education Alliance
Designation
Company Name
Physical Adress Line 1
Physical Adress Line 2
City State
Postal Code
Country
E-mail
*
example@example.com
Phone Number
-
Country Code
-
Area Code
Phone Number
Whatsapp Number
-
Country Code
-
Area Code
Phone Number
Attendance
Please indicate which days you will be in attendance
7th April 2025 Registrars Forum (AMCOA Closed Event)
8th April 2025 Opening Ceremony
8th April 2025 Workshop Day 1
9th April 2025 Workshop Day 2
10th April 2025 Workshop Day 3 (until 12h00)
Visa
Do you need a letter for visa purposes?
Yes
No
Please load Passport Biodata Page (For Security Protocol Purposes)
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Travel Details
Please provide us with your travel details (Nnamdi Azikiwe International Airport). Ground transfers in Abuja, NIgeria will be provided by the Medical and Dental Council of Nigeria upon receipt of your travel itinerary. All travel information is required by 15 March 2025. Should you have your travel details on hand, please input the details in the fields below OR upload a copy of your travel information. Should you not have your travel details yet, you will be able to come back to your registration at a later date to upload this information. Please note flights will be for your own account.
Date of Arrival
-
Month
-
Day
Year
Date
Airline
Flight Number
Time
Hour Minutes
AM
PM
AM/PM Option
Date of Departure
-
Month
-
Day
Year
Date
Airline
Flight Number
Time
Hour Minutes
AM
PM
AM/PM Option
Please load itinerary
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Hotel
Please note all delegates must finalise their own hotel bookings directly with the accredited hotel providers as detailed in the invitation letters. Please note accommodation will be for your own account.
Hotel
Abuja Continental Hotel
Stratton Hotel Asokoro
Rockview Hotel Royale
Reiz Continental Hotel
Excel Hotel and Resorts
Other
Other
Please provide details of other
General Details
Please provide us with the following information
Dietary Requirements
Please Select
No Special requirements
Strictly Halaal
Kosher
Vegetarian
No Pork
No Fish & Seafood
No Peanuts
Gluten Free
Other to be specified
Other
Please provide details of other
Do you have any special needs/requirements that we should be aware of?
None
Mobility/Physical
Vision impairment
Deaf or hard of hearing
Cognitive/Learning
Other to be specified
Other, please provide details.
Emergency Contact
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
Relation/Relationship to next of kin
Wouldyou like to receive additional marketing information from AMCOA?
Yes
No
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