REGISTRATION FORM - ANATOMICAL SOCIETY OF SOUTHERN AFRICA VIRTUAL CONFERENCE 2021

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Email *

Title *

Mrs

Professor

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First Name *

Surname *

Institutional Affiliation *

Department *

Profession *

Academic

Technician

Postgraduate student

Research Associate

Other:

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Phone Number *

Address *

City *

Country *

Membership *

If you are not a current ASSA member and wish to join to receive member rates, please complete your ASSA membership registration/renewal first and then return to this page to register for the conference. This also applies to ASSA student membership.

ASSA Member

ASSA Student Member

ASSA Non-member

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Attendance on Zoom *

Full Conference : 19-21 April 2021 (incl. AGM)

Virtual Awards evening: 20 April 2021

19 April 2021 only

20 April 2021 only

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I am presenting at the conference

Oral

Poster

Not applicable

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