REGISTRATION FORM


PAGA CONGRESS REGISTRATION



Download Congress Registration Form in PDF


    Title:
    Full Name:
    Initials:
    Preferred badge name and surname:
    PERSONAL DETAILS
    Passport number:
    Email Address:
    Phone Number (Mobile):
    Phone Number (Work):
    City:
    Country:
    Health professions registration number (If applicable)
    Special dietary requirements:
    Accommodation Single roomdoublesharingno sharing
    PAGA member? YesNon member
    Registration category Glaucoma specialistgeneral OphthalmologistGlaucoma fellowResident/Registrarmedical studentexhibitorsponsorother
    Which days will you attend:
    Conference tour: NoOption 1: Pre-conference tour (25/26 June 2024) Cape Coast/Safari Valley/ Accra ToursOption 2: Post-conference Tour (30th June, 1st July 2024) Cape Coast/ Safari Valley/Accra Tours
    COMPANY/INSTITUTION/HOSPITAL DETAILS
    Company name for invoice:
    Billing adress, city, postal/zip code,country:
    email of person responsible for payment:
    Person responsible for payment:
    CONGRESS ACTIVITIES
    Wetlab YesNo

    Let's make eye health a priority