Loading
Main Menu
+1-868: 299-0820; 299-0895; 622-4261
conference@carpha.org
Login
Speakers
Registration
Programme
Sponsorships & Exhibitors
Accommodations
Explore Saint Lucia
Login
Speakers
Registration
Programme
Sponsorships & Exhibitors
Accommodations
Explore Saint Lucia
CARPHA 68th Annual Health Research Conference
Title
Not Specified
Prof.
Dr.
Mr.
Mrs.
Ms.
First Name *
Middle Name
Last Name *
Gender
Male
Female
Occupation
Organization *
Email *
Work Address
City *
Country *
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos
Colombia
Comoros
Congo - Brazzaville
Congo-Kinshasa
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
S. Georgia and S. Sandwich Islands
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Soviet Union
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
US Virgin Islands
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
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 *
Please Select Applicable Registration Type
Awards Banquet Only
CARPHA Staff/Partner
Delegate Groups (Non-Presenter)
Presenter/Delegate
Student (Presenter)
Saint Lucia Resident (Non-Presenter)
Student Groups (Non-Presenter)
Pricing for Locals *
Not Applicable
Local ID Number *
Payment Method *
Bank Draft
Credit Card
Cash Only
Not Applicable
Online (PayPal account)
Wire Transfer
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
Accepted File Types: .jpeg, .jpg, .gif, .png, .pdf
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 *
Accepted File Types: .jpeg, .jpg, .gif, .png, .pdf
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.
Submit
Pay with Fygaro
Cancel
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
Copyright 2023 by Caribbean Public Health Agency
|
Terms Of Use
|
Privacy Statement
Back to top