Form Owner:
nsah.org
Step 1 of 3: Submit
NSAH 2023 Online Conference Registration Form
Please fill out the 2023 Conference Registration Form
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NOTE: Late fee of $50 for registration after March 10, 2023.
Name
*
Email Address
*
Address
Primary Phone
*
University Affiliation
Department
Other Employer
Position
Please indicate status:
Please check all that apply
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Faculty
Health Professions Student
Healthcare Professional/ Practitioner
Other Visiting Participant
Attending in person
Virtual Attendance
Payment
3.5 percent fee has been added to registration fee for online registration
Please click on applicable radio button to select payment amount
*
Faculty – Full Conference $375 ($388 USD)
Faculty – Daily $187 ($194 USD)
Healthcare Professional/Practitioner -Full Conference $375 ($388 USD)
Healthcare Professional/Practitioner - Daily $187($194 USD)
Health Professions Student – Full Conference $50 ($52 USD)
Health Professions Student – Daily $25 ($26 USD)
Visitor – Full Conference $375 ($388 USD)
Visitor – Daily $187 ($194 USD)
Closing banquet on Saturday, April 1, 2023, 2:00 p.m. African attire (optional).
Planning to attend banquet?
*
Yes
No
YOU WILL BE REDIRECTED TO A PAYMENT PAGE AFTER THIS FORM IS SUBMITTED.
*
indicates required fields
