2008 Algiers Ministerial Conference on Research for Health in the African Region

Narrowing the Knowledge Gap

for Africa's Health

Algiers, June 23–26, 2008

REGISTRATION FORM

Formats : Word or PDF

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COUNTRY :

NAME :

FIRST NAME :

                                       DAY                        MOUNTH                        YEAR

DATE OF BIRTH :

NATIONALITY :

OCCUPATION/EMPLOYER¹ :

PASSPORT NUMBER :

                                        DAY                        MOUNTH                        YEAR

EXPIRED DATE

OF PASSPORT

DATE OF ARRIVAL TO ALGERIA :

FLIGHT NUMBER (Arrival) :

FLIGHT NUMBER (Departure) :

CONTACT : Tel                                                                          Fax                               

                     E-mail

HOTELRESERVATION ²

HOTEL	SINGLE	DOUBLE	SUITE	PERIOD
SHERATON
RELAX
SAFIR MAZAFRAN
EMIR

 

Date :………………………………………………

Signature :

 

 

(1) Concerning journalists, attach list and reference of audiovisual material used for coverage

(2) Check the appropriate box and specify the date (duration) of stay.

 

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