ReproSex2024 - Online Registration Form

ReproSex2024 - Online Registration Form

ReproSex 2024! Your Voice Your, Rights - International Conference on Sexual and Reproductive Health 2024.
Basic information
Title*
Full Name*

First NameLast Name
Preferred name for the name tag*
NIC / Passport no.*
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Gender*
Age*
Nationality*

Sri Lankan CitizenForeign Citizen
Country*
Affiliation (Company/Institution)*
Job Title/Position*
What is your highest level of educational attainment?*
Have you submitted an abstract?*
Please provide the reference number.
Contact Information
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
WhatsApp Number

Country CodeArea CodePhone Number
Emergency Contact Information
Name*

First NameLast Name
Phone Number*

Country CodeArea CodePhone Number
Email*
example@example.com
Preferred Mode of Participation *
*Only international presenters are eligible to attend the conference virtually.
Registration Fee
Packages for Sri Lankan Participants
Conference package for Sri Lankan Participants - Adults*

Early bird registration for both days (Before 30th September 2024) - 2500 LKRRegistration for both days - 3500 LKRRegistration per day - 2000 LKR
Conference package for Sri Lankan Participants - Youth*

Early bird registration for both days (Before 30th September 2024) - 1500 LKRRegistration for both days - 2000 LKRRegistration per day - 1500 LKR
Packages for International Participants
Conference package for International Participants - Adults*

Early bird registration for both days (Before 30th September 2024) - 50 USDRegistration for both days - 75 USDRegistration per day - 40 USD
Conference package for International Participants - Youth*

Early bird registration for both days (Before 30th September 2024) - 30 USDRegistration for both days - 40 USDRegistration per day - 25 USD
Please pay your registration fee via cash or check to the following account and upload the payment slip afterward.

Account Name : The Family Planning Association of Sri Lanka
Account Number : 003010530110
Bank Name : Hatton National Bank
Branch Name (Code) : Head Office Branch (003)
Swift Code : HBLILKLX

*Please ensure your unique ID is clearly indicated on the payment slip, either by typing it as the reference or writing it by hand. This is crucial for accurate payment tracking.
** Your Unique ID **
Upload Payment Slip*

Please ensure you include your unique ID on the payment slip before uploading it.
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Logistic Information
Meal Preferences*

Non-VegetarianVegan
Meal Attendance Preference*

A. 5th Tuesday Morning RefreshmentsB. 5th Tuesday LunchC. 5th Tuesday Evening RefreshmentsD. 6th Wednesday Morning RefreshmentsE. 6th Wednesday LunchF. 6th Wednesday Evening Refreshments
Do you require parking?*

A. Yes - November 5th onlyB. Yes – November 6th onlyC. Yes - Both daysD. Not required
Visa Support
Do you require visa support?*

YesNo
If you need an invitation letter, please upload a copy of your passport to assist with the preparation of the letter.

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Date of arrival

MonthDayYear
Date
Date of dipature

MonthDayYear
Date
If you need any additional support for your visa application, please specify the assistance required.
Other
How did you first hear about the ReproSex 2024 conference?*
Please specify*
Should be Empty:

ReproSex2024 - Online Registration Form

Basic information

Contact Information

Emergency Contact Information

Registration Fee

Packages for Sri Lankan Participants

Packages for International Participants

Logistic Information

Visa Support

Other