Pre-Registration

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Name:

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Cell Number:

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Email Address:

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Are you:

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Are you or someone in your immediate family, a current AKUH employee or student?

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Including yourself, how many people would be attending the event?

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How did you get to know abut this event? Please select as many as applicable.

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Which of the following AKUH services have you or your immediate family used in the last 2 years? Please select as many as applicable.

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Please let us know why you are interested in this event. Please select as many as applicable.

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