Q.1
Name of Organization
Q.2
Name of attendee - Please register each person attending individually
*
Q.3
Contact email of atendee
*
Q.4
What region(s) do you work in Haiti?
*
Ouest
Sud
Sud-est
Nippes
Grand 'Anse
Centre
Artibonite
Nord
Nord- est
Nord-ouest
Q.5
What medical services do you offer? Check all that apply
*
Primary care
Vision
Dental
Xray
Prosthetics
Obstetrics- Delivery services
Prenatal/ post natal care
Hospital Services- Open 24-7
Ultrasound
Surgical Services
Lab services
Q.6
Would you like to set up a booth at the conference?
Yes
No