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DAYS	HOURS	MINUTES	SECONDS

13th World Congress on Public Health

April 23-27, 2012 Addis Ababa, Ethiopia

REGISTRATION FORM

First Name

Last Name

Organization

Nationality

Telephone Number

EPHA

Member
Non-Member

Registration Fee

Regular 200 Birr
Student 100 Birr

Payment can be made in person at EPHA Office /way to Meskel Flower about 500 mt from Dembel Building/ or by Bank Wire Transfer to the following account of the Ethiopia Public Health Association (EPHA):

Bank Name & Address: Commercial Bank of Ethiopia

Branch Name: Addis Ababa Branch

Account Number: 01718-532037-00

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