Full Name*
Gender*	Male Female
Country*
Organization*
Telephone*
Facsimile
E-mail*
Conference registration fees (Dhs 100 per person)
Please pay the registration fee at the conference venue (Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain) on either January 25 or 26 depending on your arrival date. Travel Information Please ensure the accuracy of the information submitted below
Arrival		Departure
Date*		Date*
Time		Time
Flight Number		Flight Number
Transport (between airport & Al Ain) Please Choose Required Not Required		Transport (between Al Ain & airport) Please Choose Required Not Required
Accomodation
Hostel	Please Choose Required Not Required
How many nights	Please Choose 1 2 3 4 5
Date from		To
If you require hotel accomodation may we suggest you book online with one of the following hotels: Al Ain Intercontinental Hotel Hilton Al Ain  Al Ain Rotana Hotel Mercure Grand Hotel Special room rates are available for conference attendees. For further information please contact Fields marked * are mandatory Special dietary requirement   if yes provide details: (eg. Vegetarian, Allergy)