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Myanmar Liver Symposium Registration
Please complete all required fields!
First name
*
Please enter your first name.
Last name
*
Please enter your last name.
Organization
*
Please enter your organizations name.
Degree(s) and/or title(s)
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Area of expertise and/or interest
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Street address
*
Please enter your address.
City or township
*
Please enter your city.
State or region
*
Ayeyarwady Region
Bago Region
Chin State
Kachin State
Kayah State
Kayin State
Magway Region
Mandalay Region
Mon State
Rakhine State
Shan State
Sagaing Region
Tanintharyi Region
Yangon Region
Naypyidaw Union Territory
other
Please select a state/region.
If other, please enter:
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Postal / zip code
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Country
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Email address
*
Please enter a valid email address.
Phone number
*
Please enter your phone number.
We are pleased to offer real-time, simultaneous interpretation from English to Myanmar during the conference.
Please check whether you will need interpretation services
yes
no
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We are pleased to offer a limited amount of scholarship funds to attend the symposium.
Please check whether you wish to be considered for a scholarship award
yes
no
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Do you have any dietary restrictions? If so, please state:
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Do you plan to attend both days of the symposium?
yes
no
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If not, please indicate the days you plan to attend:
Day 1 only
Day 2 only
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What's your T-shirt size?
*
extra small
small
medium
large
Please select a t-shirt size.
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For more information, please
click here
to view the flyer for this event.
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