Annual Convention Registration Form

Payment in full must accompany registration.  Please follow the appropriate procedures:

  1. For those paying in Nigeria, pay appropriate fee at any branch of Fidelity Bank.  Account Name: ANPA
    After paying at the bank, the registrant should contact the NMA office by phone and complete the registration.

For Payment in Naira use account # 082441010000082                                                                                 
For Payment sent in USD use account # 082509020001656

Send a copy of teller advisory AND completed  registration form by email to:
Nigerian Medical Association, 8 Benghazi Street, Off Addis Ababa Crescent, Wuse Zone 4, FCT, Abuja. E-mail    info@nigeriannma.org.  Phone:   08035870494; 08055243259;  09-8709249

ACCOMMODATIONS:
Transcorp Hilton  1 Aguiyi Ironsi St., Maitama, Abuja.
Tel: + 234 (0) 413 4328 (DL& Fax)
E mail: Abuja@hilton.com  
Web site: www1.hilton.com/en_US/hi/hotel/ABUHITW-Transcorp-Hilton-Abuja/index.do

Room rate is $185 per night, single or double.

Name
        
               First                                 (M)                  Last                    
Title
Address
City
State
Zip Code
Office Phone
Home Phone
Fax ex 650-555-1212 x1234
Email
Payment Information
Check/Money Order
 Amount Enclosed $  

If you make a mistake in your selection below , please uncheck Appropriate Box To Clear

Please check applicable box on left and then check applicable price box.
  Membership Dues Amount Total
Renew Full Membership $365 $
Renew Associate Membership $100 $
         
  Conference Registration; for ANPA and MANSAG members    
Physicians/Dentists Member (fee waived for ANPA member whose 2009 dues are paid in full) $365 $
Fellows, RNs, PAs, Pharmacists $200 $
Residents, Interns $150 $
Students/Guests $100 $
Spouses, Non-Medical Personnel, Other $250 $
NMA Members
Non-NMA Members		 $100
$200
 $
   
   
Annual Banquet $80/ person
No. of persons 		$
Transcorp Abuja Hilton Hotel Room $236/ night
No. of nights  
between July 13-22
Start Date:
End Date: 		$
Total $

Print Registration Form.Refer to print invoice

 
Nigerian Medical Association,
8 Benghazi Street,
Off Addis Ababa Crescent,
Wuse Zone 4, FCT, Abuja.
E-mail    info@nigeriannma.org
Phone:   08035870494; 08055243259;  09-8709249

Mr Abiodun F Fakokunde, FWACS, MRCOG
Secretary General MANSAG,
60 Greenwich Way
Waltham Abbey.
Essex EN9 3YS
Telephone: +447939096898
Email: secretary@mansag.org
     
 
 ANPA
c/o Nkem Chukwumerije
National Treasurer
28414 Redwood Canyon
Santa Clarita, CA  91390
Fax: 661-296-1988
Secretariat:  330-677-0400  anpasecretariat@sbcglobal.net