QA6 Registration Form

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Email *

First Name *

Last Name *

Email Address *

Affiliation *

Gender

Female

Male

Prefer not to say

Clear selection

Which of these best describes you? *

I am a student

I am a postdoc

I am an academic

I work in industry

Other:

Country where you work (or study) *

Will you be attending in person or online? *

In person

Both in person and online

Do you plan to give a talk or poster? *

A talk

A poster

Neither a poster nor a talk

Title of your planned talk/poster

Abstract of your planned talk/poster

My registration fees are: *

$0 since I am a student working in Africa

$25 since I am a postdoc working in Africa

$50 since I am a student/postdoc working outside Africa

$150 since I am an academic working in Africa

$400 since I am an academic working outside Africa

$900 since I work in industry

I will be paying the registration fees *

by bank/money transfer (See bank details above)

upon arrival in Kigali

by neither means since I will be attending online

by neither means since I am a student working in Africa

I would like to DONATE to QA6
*

Yes [See details for donation above]

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