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+1-868: 299-0820; 299-0895; 622-4261
conference@carpha.org
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About
Speakers
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Highlights
Login
About
Speakers
Programme
Sponsorships & Exhibitors
Highlights
Online Registration Closes on Monday 5
th
May at 12 noon
There are no conferences open for registration.
CARPHA Conference Registration
Title
Not Specified
Prof.
Dr.
Mr.
Mrs.
Ms.
First Name *
Middle Name
Last Name *
Gender
Male
Female
Occupation
Organization *
Email *
Work Address
City *
Country *
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Phone
55555555555, +5-555-555-5555, +5(555) 555 5555 [w/o the +5] [- or spaces]
Fax
55555555555, +5-555-555-5555, +5(555) 555 5555 [w/o the +5] [- or spaces]
Mobile *
55555555555, +5-555-555-5555, +5(555) 555 5555 [w/o the +5] [- or spaces]
Registration Type *
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*
Please register via email to
finance-conference@carpha.org
containing list of participants.
*
Please submit a copy of your ID as an attachment on the form.
Pricing for Locals *
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Local ID Number *
Payment Method *
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Instructions to remit funds to CARPHA (US Account)
*
Please ensure that you return to this site after payment has been made to complete your registration.
Credit Card Authorisation Form
, Please fax or email a signed copy to CARPHA at 868-622-2792 or
finance-conference@carpha.org
Emergency Contact *
Emergency Phone *
55555555555, +5-555-555-5555, +5(555) 555 5555 [w/o the +5] [- or spaces]
Allergies and Special Needs
Additional Attachment
(where applicable)
Student Status Letter, National ID Card, etc
Opt in to accept notifications about conference via SMS/email
Credit Card Authorisation Form
This form has been created in order to allow you to have (CARPHA) conference fees charged to your credit card. Please provide all the information requested below along with a copy of a valid form of identification to ensure prompt processing of registration fees. If you have any problems please call 868-622-4261.
Card Holder Information (Name as it appears on the credit card) *
Card Type *
Visa
Mastercard
Account Number *
Expiry Date *
Valid Form of Identification *
I certify that all information is complete and accurate. I hereby authorize Caribbean Public Health Agency to collect payment for all charges as indicated in the payment information section of this form by processing a charge to the credit card listed above. I certify that I am the authorized signer of the credit card listed above.
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Pay with Fygaro
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CARPHA Head office
16-18 Jamaica Blvd,
Federation Park,
Port of Spain,
Trinidad & Tobago
+1-868: 299-0820; 299-0895; 622-4261
CARPHA Jamaica
Hope Gardens,
Kingston 6,
Jamaica
+1-876: 977-3540; 702-4235
+1-876: 977-0974
CARPHA St. Lucia
P.O. Box 1111,
The Morne, Castries,
Saint Lucia
+1-758:452-2501; 452-1087
+1-758: 453-2721
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