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 Choose Government Agency Hospital Industry Laboratory Other (please specify)

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 Choose Basic Science Researcher Clinical Science Researcher Clinical Practitioner Industry Professional Nurse - HealthCare Practitioner Trainee Other (please specify)

Professional role, other

Professional role, other

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

Specialty Immunology Infectious Diseases Microbiology Neonatology Obstetrics and Gynecology Pediatric Infectious Diseases Pediatrics Public Health and Preventive Medicine Vaccinology Other (please specify)

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