2nd UGANDA ALCOHOL POLICY VIRTUAL CONFERENCE 2020 (UAPC-20)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

MOBILIZING PARTNERSHIPS AND COMMUNITY ACTION FOR A SOCIETY FREE OF ALCOHOL HARM.

Please note that participation at UAPC2020 is not open to any person who has a conflict of interest due to financial relationships, direct or indirect with the alcohol industry.

First Name *

Please indicate your first name as it appears on your identity card

Last Name *

Please indicate your last name as it appears on your identity card

Gender *

Female

Male

Date of Birth *

YYYY

Nationality *

Please indicate your country of nationality

Agency / Place of work or study for students *

Indicate your place of work or school name for students

Designation *

What is your work title at your organisation

Telephone Contact *

Please provide all your active phone numbers below by entering each number on a new line

Address *

Please indicate your full physical address

Email *

Provide an active email account we shall be communicating to your via this email address

Attendance Status *

Will be attending in person or you prefer to join the conference via an online virtual platform

Physical (75,000/= Ugx per day)

Virtual online platform (Free)

Please indicate if you want to submit an abstract *

Participants who wish to present at the UAPC2020 conference must submit an abstract for their presentation

Yes

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms