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Sickle Cell Disease African Scientific Symposium 2026 – Keynote Speaker form

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Sickle Cell Disease African Scientific Symposium 2026 – Keynote Speaker & Special Guest Information Form

Thank you for participating in the Sickle Cell Africa Symposium scheduled for July 30th – 31st, 2026, at Marriott Hotel, Ikeja, Lagos.

Sickle Cell Disease African Scientific Symposium 2026

PERSONAL INFORMATON

Full Name

Title / Designation

Organization / Institution

Email

Phone Number (WhatsApp preferred)

Country of residence

PARTICIPATION DETAILS

Role at the Symposium

Keynote Speaker

Guest Speaker

Panelist

Special Guest

Others

Topic / Area of Contribution

Short Professional Bio (150–200 words)

Upload your Headshot Photograph

Choose File

Do you require any special AV or presentation equipment?

Laptop

Projector

Laser Pointer

Audio Playback

Internet Access

None

Others

Upload your Presentation Slides (optional)

Choose File

TRAVEL & ACCOMMODATION

Are you being sponsored by the Organizers?

Yes

No

If Yes, Provide passport name, departure city, preferred airline, and any relevant details.

Upload Data page of International Passport

Choose File

Do you require hotel accommodation?

Yes

No

Check-in Date (if accommodation required)

Check-Out

Dietary Restrictions or Health Considerations

MEDIA & PERMISSION

Do you consent to your photos/videos being used for symposium communication & publications?

Yes

No

Social Media Handles (optional)

ADDITIONAL INFORMATION

Any additional requests or information for the organizing committee?

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