NSAH 2025 Online Conference Late Registration Form

Please fill out the 2025 Conference Registration Form (late fees have been added)

Access and Opportunities for Minority Allied Health Professionals

**NOTE: Late fee of $50 for registration after March 3, 2025.

Name Email Address Address Primary Phone University Affiliation Department Other Employer Position

Please indicate status:

Please check all that apply Faculty Health Professions Student Healthcare Professional/ Practitioner Other Visiting Participant Attending in person Virtual Attendance

Banquet

Closing banquet on Saturday, March 29, 2025, 2:00 p.m. African attire (optional).

Planning to attend banquet? Yes No

NSAH 2025 Online Conference Late Registration Form

Please indicate status:

Banquet

Payment

A late fee of $50 has been added to registration fee

3.5 percent processing fee has been added to registration fee for online registration

YOU WILL BE REDIRECTED TO A PAYMENT PAGE AFTER THIS FORM IS SUBMITTED.