Registration form

Title

Title

First Name

First Name

Last Name

Last Name

City

City

Email Address

Email Address

Repeat Email Address

Repeat Email Address

Mobile Phone Number

Mobile Phone Number

Twitter

Twitter

Main workplace type

Main workplace type

Workplace type, other

Workplace type, other

Do you need a letter to request travel visa?

Do you need a letter to request travel visa? Yes
No
List of the countries requiring visa to enter Costa Rica

Passport number

Passport number

Passport issuing country

Passport issuing country

Expiration date

Expiration date

Professional role

Professional role

Professional role, other

Professional role, other

Specialty (Hold down the control (ctrl) button to select multiple options)

Specialty

Specialty, other

Specialty, other

Please, choose your registration category

Please, choose your registration category Full
Trainee
LI, LMI, Latin American & Caribbean Countries Trainees Travel Bursary
Speakers/Moderators

To apply for the travel bursary for Low Income, Low / Middle Income, Latin American & Caribbean countries, please check all boxes below. If any of them does not apply to you, please register with another category.

I reside in a LI / LMI, Latin American or Caribbean Country
I am currently a student, resident or fellow in training
I will be submitting an abstract as first / presenting author

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Thank you for registering to INMIS 2024.
Confirmation of travel bursaries will be sent jointly with abstracts notification.

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