Patient & Caregiver Registration Please type in upper and lower case letters. (ex: Adekunle Gold) All fields marked with an asterisk * are required. I Am A* PatientCaregiver Full Name: * Email: * Phone: * please add (+ country code) Job Title/Position: * Organization/Institution: * Address: * City * State Zip/Postal Code Country * —Please choose an option—Nigeria---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d’IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Dietary Requirements (if any food allergy, vegan, vegetarian or gluten-free) Please indicate if any dietary requirements Your Interests Are you interested in any of the following networking events?* ACSCD 2019 Welcome ReceptionACSCD Patient Advocacy ReceptionSickle Cell in Focus Hubs/Micro-sessions Are you interested in any of the these side events?* Africa Sickle Cell Leaders' Summit MeetingWomen Overcoming Sickle Cell Symposium How did you hear about ACSCD 2019?* Call from ACSCD TeamWord of mouthE-mail/E-newsletter from Event PartnersPrint advertOther E-mail from ACSCD TeamSocial MediaExhibitorSpeaker Thank you for registering and we look forward to welcoming you to Lagos in October, 2019! ACSCD Team [reg_code reg-code] REGISTER Thank you! We will get in touch with you shortly.