Name *

First Name

Last Name

I am registering as: *

Clinician

Laboratory scientist

Patient or patient family

Pharmaceutical or commercial company representative

Other

Following this workshop, we would like to share publications/reports, workshop presentation materials, abstracts and other information such as details of future workshops, with all participants. This will facilitate future communication and collaboration. Please indicate below your consent for your contact details (name and email address) to be shared with the other workshop participants: *

Yes

No

I would like to be included on an email mailing list held by the organisers of the Alport Syndrome Alliance workshops for future Alport workshop communications *

Yes

No

What type of registration? *

Clinicians and laboratory scientists - £440.00

Reduced rate - Students/Retirees/Clinicians from low and middle-income countries £175.00

Patient or patient family - £130.00

Local clinicians and laboratory scientists working in Cyprus, Greece or Turkey - GBP £130

Local patients based in Cyprus, Greece or Turkey (for Patient day only – 13 March) - FREE

Pharmaceutical company representatives not sponsoring workshop - £1350.00

Sponsor - FREE

Please give us the name(s) of anyone you think we should invite to the workshop who may not have participated in an Alport workshop before, particularly early career researchers or students:

First Name

Last Name

Name

First Name

Last Name

Do you need a certificate of participation?

Yes

No