Registration Form

This form is intended to register you for the 2019 ICMA National Conference for Medical Professionals! to be held in Kharkov, Ukraine on October 11-13, 2019. There is a fee associated with attending the conference.

When the form is submitted that will notify the coordinator for your local city. This coordinator needs to be contacted in order to make payment of your registration a fee for the conference. If you are traveling internationally the ICMA Team will act as your coordinate internationally the ICMA Team will act as your coordinator.
We need the name of your university or institution to coordinate additional details.
Please enter your full name and title as required.
Please provide a telephone number so the coordinator of registration can contact you if needed.
Enter the email address where we can contact you immediately.
Please enter your nationality.
Where are you from in your homeland?
What is your current year of study?
Are you a vegetarian?
Yes, I understand my picture may be taken during the conference and give my permission to use my photograph in future published material or online promotion.
Yes, I permit my contact information to be shared with Christian Medical Organizations in my home country.
Any specific details we need to know or other helpful details about contacting you?

Please verify you have answered all the questions.

reCAPTCHA is required.
Just so we can tell you are really a person and not a bot.