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24TH BIENNIAL CONFERENCE & SCIENTIFIC MEETING OF MEDICAL WOMEN ASSOCIATION OF NIGERIA: Form for 24TH BIENNIAL CONFERENCE
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24TH BIENNIAL CONFERENCE & SCIENTIFIC MEETING OF MEDICAL WOMEN ASSOCIATION OF NIGERIA: Form for 24TH BIENNIAL CONFERENCE
24TH BIENNIAL CONFERENCE & SCIENTIFIC MEETING OF MEDICAL WOMEN ASSOCIATION OF NIGERIA
Title
- Select -
Prof
Dr
Mr
Mrs
Ms
Registrant Details
First Name
Last Name
Email
Email
Confirm Email
Phone Number (WhatsApp)
Mode of Participation
- Select -
Physical
Virtual
MDCN Folio Number: (Only medical doctors)
State of practice/State of membership:
--Select an Option--
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
Federal Capital Territory (FCT)
Institution
Age Category
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YDF (up to 40 years)
Middle age (41 to 59 years)
Senior Member (60 years and above)
Current position in MWAN
- Select -
Regular Member
Associate Member
State Exco
National Exco
Non Member
Disability declaration
- Select -
Yes
No
Specify the disability
Are you presenting a paper
- Select -
Yes
No
Regular
Amount
Quantity
- None -
1
2
3
4
5
Virtual
Amount
Quantity
- None -
1
2
3
4
5
Associate Member
Amount
Quantity
- None -
1
2
3
4
5
Payment
Amount
