Conference Fee Waiver Request

Africa Best of St. Gallen Breast Cancer Conference 2026 Complimentary Registration Nomination Form

Fill out this waiver form to request exemption from conference and workshop fees, then submit it back to the organizer.
Section 1 – Personal Information
Full Name (as on National ID/Passport)

First NameLast Name
Title
Gender
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Section 2 – Professional Information
Institution
Department
Position
Specialty
Country
Governorate (for Egypt)
Years of Experience
Section 3 – Contact Information
Email
example@example.com
Mobile Number

Area CodePhone Number
WhatsApp Number

Area CodePhone Number
Office Telephone

Area CodePhone Number
Section 4 – Registration Category
Registration Category
Section 5 – Nomination Information
Who nominated you?
Name of nominator
Section 6 – Scientific Participation
Will you submit an abstract?
Abstract Title
Presentation Preference
Section 7 – Workshops
Which workshop would you like to attend?
Section 8 – Dietary Requirements
Section 9 – Consent
Consent
Which fees are you requesting to be waived?
Please provide any additional information or justification for your waiver request
Organization/Institution Name
Role/Title
Conference/Workshop Session(s) You Plan to Attend
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number

Area CodePhone Number
Preferred Contact Method

Other

Africa Best of St. Gallen Breast Cancer Conference 2026 Complimentary Registration Nomination Form