Full Name * Gender * --Select Option-- Male Female Phone Number Email Address * Upload Your Passport Photograph Category * --Select Option-- Worker Student/Retiree Work Facility * --Select Option-- Private Public Facility (Public Type) --Select Option-- State Federal Place of Work * Address of Place of Work * Profession * --Select Option-- MEDICAL MEDICAL LABORATORY SCIENCE PHARMACY NURSING PHYSIOTHERAPY COMMUNITY HEALTH OPTOMETRY ENVIRONMENTAL HEALTH ACCOUNTING LAW BIOMEDICAL ENGINEERING ADMINISTRATION WORKS AND MAINTENANCE DIETETICS AND NUTRITION OTHERS (SPECIFY) Profession (Specify) Medical Specialty * --Select Option-- MAXILLOFACIAL SURGERY MEDICINE FAMILY MEDICINE MICROBIOLOGY HAEMATOLOGY HISTOPATHOLOGY RADIOLOGY PAEDIATRICS COMMUNITY MEDICINE OBSTETRICS AND GYNAECOLOGY ORTHOPAEDICS RADIOONCOLOGY CHEMICAL PARTHOLOGY PSYCHIATRY ANAESTHESIA OPHTHALMOLOGY OTHERS (SPECIFY) Medical Specialty (Specify) Institution of Study Course of Study Islamic Association Membership * --Select Option-- MSSN ISMA AHMSS PMSS NONE OTHERS (SPECIFY) Islamic Association (Specify) Student ID Card IMAN State Chapter * --Select Option-- ABIA ADAMAWA AKWA IBOM ANAMBRA BAUCHI BAYELSA BENUE BORNO CROSS RIVER DELTA EBONYI EDO EKITI ENUGU GOMBE IMO JIGAWA KADUNA KANO KATSINA KEBBI KOGI KWARA LAGOS NASARAWA NIGER OGUN ONDO OSUN OYO PLATEAU RIVERS SOKOTO TARABA YOBE ZAMFARA FCT ABUJA None IMAN Branch Route of Transportation * --Select Option-- Road Train Air Other Transportaion Route (Specify) Health Condition * --Select Option-- Hypertension Diabetes Asthma Sickle Cell Other None Health Condition (specify) Conference Fee * Physical – ₦30,000.00 Virtual – ₦25,000.00 Pre-conference Workshops (Optional) Cooperative Workshop – ₦10,000.00 Addiction Prevention worshop – ₦10,000.00 Psychotrauma Workshop – ₦25,000.00 Ibadah Friendly Workshop – ₦10,000.00 Leadership Workshop – ₦10,000.00 Discount: Coupon (Optional) Apply Coupon Register and Pay Please Wait… If you encountered any issue completing this registration, kindly reach out to 08035012930 for assistance Share this: Share on X (Opens in new window) X Share on Facebook (Opens in new window) Facebook Share on WhatsApp (Opens in new window) WhatsApp Share on Telegram (Opens in new window) Telegram Share on LinkedIn (Opens in new window) LinkedIn
