AMCOA2025 Annual Capacity Building Workshop Registration Form (Local)

AMCOA 2025 Annual Capacity Building Workshop Registration Form(Local Delegates) (10 CPD Points)

Please book for your spot at the AMCOA Annual Capacity Building Workshop by filling the form below.
Personal Details
Title
Full Name*

First NameLast Name
Preferred Name for Badge*

First NameLast Name
Industry

AcademiaAdministratorsFinance and Professional ServicesGovernmentHealthcare services & providers,Health Insurance and Health Management Organisations (HMO)MediaNGOPharmaceuticalsRegulatory Authority/ AgencyTechnology and InnovationOther
Other
Please provide details of other
First Time Attendee

YesNo
Member Affiliation*

Local Delegate (Nigeria)Other
Other
Please provide details of other
Designation
Company Name
Physical Adress Line 1
Physical Adress Line 2
City State
Postal Code
Country
E-mail*
example@example.com
Phone Number

Country CodeArea CodePhone Number
Whatsapp Number

Country CodeArea CodePhone Number
Attendance
Please indicate which days you will be in attendance

7th April 2025 Registrars Forum (AMCOA Closed Event)8th April 2025 Opening Ceremony8th April 2025 Workshop Day 19th April 2025 Workshop Day 210th April 2025 Workshop Day 3 (until 12h00)
Visa
Please load Passport Biodata Page (For Security Protocol Purposes)

Cancelof
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

MonthDayYear
Date
Airline
Flight Number
Time

Hour Minutes

AM/PM Option
Date of Departure

MonthDayYear
Date
Airline
Flight Number
Time

Hour Minutes

AM/PM Option
Please load itinerary

Cancelof
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 HotelStratton Hotel AsokoroRockview Hotel RoyaleReiz Continental HotelExcel Hotel and ResortsOther
Other
Please provide details of other
General Details

Please provide us with the following information
Dietary Requirements
Other
Please provide details of other
Do you have any special needs/requirements that we should be aware of?

NoneMobility/PhysicalVision impairmentDeaf or hard of hearingCognitive/LearningOther to be specified
Other, please provide details.
Emergency Contact*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Relation/Relationship to next of kin
Wouldyou like to receive additional marketing information from AMCOA?

YesNo
NOTE: Registration Payments for Local Delegates will be processed through Medical and Dental Council Nigeria via https://login.remita.net/remita/onepage/MDCN/biller.spa
NOTE: Invoice to follow.
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AMCOA 2025 Annual Capacity Building Workshop Registration Form(Local Delegates) (10 CPD Points)

Personal Details

Attendance

Visa

Travel Details

Hotel

General Details