ICPHC Abstract Application 
This form will close for all submissions on May 30 2023. Entries received after this date will join a waitlist. Please check the website for further guidance about applying to present.

Contact email. Please enter an email that will be regularly monitored as we will use this to communicate the outcome of your application and other important details.

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Email *
All presentations will be delivered in person at the conference in Addis Ababa September 6 & 7 2023. Please confirm you will present your work in person if you are selected. *
Applicant Information
Please enter the details of the lead applicant or presenter in this section
First Name *
Family Name *
Salutation *
Job title *
Organization or main affiliation *
Applicant's location of operation/station (this may be different from applicant's citizenship) *
Gender. We collect this information for diversity monitoring purposes. *
Age range. We collect this information for diversity monitoring purposes. *
Do you consider yourself to be a person with a disability. We collect this information for diversity monitoring purposes *
Applicant's area of professional expertise. Please check all that apply
Is the applicant a full time student? *
Full time students only - please list the name of the institution and course enrolled in.
Organization Type
Clear selection
Abstract Title *
Abstract Body (2000 characters) *
Session Objective *
Please list details of additional authors or proposed presenters of this abstract, if applicable
Abstract Presentation Category - First Preference *
Abstract Presentation Category - Please indicate if you are interested in being considered for a different presentation type if your first preference is not available *
Required
Conference Theme  - Please indicate the primary conference theme this abstract is aligned with. See guidance on website for more details *
PHC Levers  - Please indicate which PHC levers this abstract focuses on. Check all that apply. See guidance on website for more details *
Required
Which geographic region will this abstract focus on. Please check all that apply. *
Required
Lead applicant or presenter bio *
Presentation language *
Please add any further information or links which may support your application
Scholarship Applicants:  *
We may have a limited scholarship fund available for exceptional applicants from LMIC and regions who are not able to secure funding to support attendance from their employer/organization. Please indicate here if you wish to be considered for a scholarship and then answer the next two questions before submitting your form.
Scholarship Applicants: 
If you have answered, 'yes' above, please explain in detail why you are requesting support from the scholarship fund.  This information will be reviewed by the Scholarship Committee. You may be asked to provide additional information if you are considered for a scholarship.
Scholarship Applicants: Where will you be travelling from? City/region and Country.
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