Type of Training/Opportunity Workshop Dates of Event Mon, Jul 24 to Wed, Jul 26 2023 Tentative Meeting Overview: Subject to Change ➢ Day 1 – NCDs and HIV ➢ Day 2 – HIV and Co-Infections ➢ Day 3 – HIV across the lifespan Personal Details Please provide details as it appears on your passport for the purposes of invitation letter/VISA application ,and for the Badge name. Please not that reprinting will not be prioritized. Title - Select -ProfDrMrMrsMs First Name Middle Name Last Name Email Contact Number Please include the country code Institution Country of Residence - Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands The country where you currently reside in Nationality - Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Do you have a disability? 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Biography H3A Involvement Role Role - Select -FellowMSc StudentPIMPICo-PIPhD StudentPost DocStudy CoordinatorTraineeOther… Enter other… H3Africa PI Affiliation H3Africa PI Affiliation - Select -H3Africa PI: Anita GhansahH3Africa PI: Adeyinka AshayeH3Africa PI: Akin AbayomiH3Africa PI: Alash'le AbimikuH3Africa PI: Alfred Amambua NgwaH3Africa PI: Alice MatimbaH3Africa PI: Ambroise WonkamH3Africa PI: Ayesha MotalaH3Africa PI: Christian HappiH3Africa PI: Clement AdebamowoH3Africa PI: Dan SteinH3Africa PI: Daniel MasigaH3Africa PI: David KateeteH3Africa PI: Dissou AffolabiH3Africa PI: Dwomoa AduH3Africa PI: Elizabeth MayneH3Africa PI: Erisa SabakakiH3Africa PI: Enock MatovuH3Africa PI: Ezekiel AdebiyiH3Africa PI: Getnet TadeleH3Africa PI: Gobeni AmeniH3Africa PI: Guida LandoureH3Africa PI: Heather ZarH3Africa PI: Hugh-George PattertonH3Africa PI: Jantina De VriesH3Africa PI: Joseph OchiengH3Africa PI: Kidist BoboshaH3Africa PI: Leon MutesaH3Africa PI: Lynn MorrisH3Africa PI: Mark EngelH3Africa PI: Mayowa OwolabiH3Africa PI: Michele RamsayH3Africa PI: Michelle SkeltonH3Africa PI: Mogomotsi MatshabaH3Africa PI: Moses JolobaH3Africa PI: Nicola MulderH3Africa PI: Oyedunni ArulogunH3Africa PI: Rufus AkinyemiH3Africa PI: Seydou DoumbiaH3Africa PI: Solomon Ofori-AcquahH3Africa PI: Zane LombardDBACWelcome Trust/SFANIHIECInvited GuestsExhibitorsOther… Enter other… H3Africa Project Affiliation H3Africa Project Affiliation - Select -ACCMEAFBRECANE StudyAfrican Neurobiobank for Precision Stroke MedicineAWI-GenBEAMINGBRecABurden, spectrum and aetiology of type 2 diabetes in sub-Saharan AfricaCAfGENClinical and Genetic Studies of Hereditary Neurological Disorders in MaliRAFAgeneDDD-Africa - Evaluating Clinical Exome Sequencing in an African SettingDeveloping best practices of Community Engagement for Genomics and BioBanking in Africa CEBioGenDevelopment of H3 Africa Biorepositories to facilitate studies on Biodiversity, Disease & Pharmacogenomics of African PopulationsEANBiTEstablishment of an H3Africa Biorepository at Clinical Laboratory ServicesEthical and social issues in informed consent processes in African genomic researchExploring Perspectives on Genomics and Sickle Cell Public Health InterventionsEyes of Africa: The Genetics of BlindnessELSIEnhancing Ethiopian Youths' Literacy about the Gene x Environment Contributions to Health Using the context of PodoconiosisGenetics and genomic researching Uganda: Towards context specific ethics guidelinesGenetic interactions between human populations and malaria parasites in different environmental settings across AfricaGenomic Characterization and Surveillance of Microbial Threats in West AfricaGenomics Inheritance Legal and Social IssuesH3ABioNet: a sustainable African Bioinformatics Network for H3AfricaH3Africa Administrative Coordinating Centre: Enabling and Supporting Genomics and Health Research Capacity Building in AfricaH3Africa Kidney Disease Research NetworkHI-GENES AfricaImmunoglobulin gene diversity in an African population and impact on antibody function in HIV infectionINDIGENE StudyIFGeneRAI-HABIBRH3AUReprogramming of the Trypanosoma brucei Epigenome during Human Infection: Opportunities for New TherapiesRAFgeneReMACRHDGenSickleGenAfrica:Sickle Cell Disease Genomics Network of AfricaSIRENStigma in African genomics research on Schizophrenia and Rheumatic Heart DiseaseSystems Biology for Molecular Analysis of Tuberculosis in EthiopiaTBGENAfricaThe Genomics of Schizophrenia in the South African Xhosa PeopleThe Nasopharyngeal Microbiome and Respiratory Disease in African ChildrenTransgenerational Effects of Maternal Stressors: Investigating the Role of Infant Gene ExpressionTransgenerational Epigenomics of Trauma and PTSD in RwandaTrypanoGEN +: The Genetic Determinants of Two Neglected Tropical DiseasesWest African Center of Excellence for Global Health Bioinformatics Research TrainingWASLITBREDBACIECFunderNot ApplicableOther… Enter other… Are you applying for travel support? Yes No Motivation Your motivation must please speak to your research and scientific contribution to the topic of HIV/AIDS and Infectious diseases and how your participation in this workshop will enhance your career and impact your organization. VISA Application Do you anticipate requiring assistance with VISA application? Yes No https://immigration.ecitizen.go.ke/index.php?id=6 Passport Number Information message The data collected from this registration form will be used to manage Consortium Meeting logistics. In the longer term the data will also be used to add you to the various H3Africa project resources, the biographies, pictures and domain expertise collected may be used to create webpage profiles for each member and project. The personal information provided such as email addresses will not be shared with third party members outside the H3Africa Consortium, Consortium Meeting Planning Committees, online service providers and H3ABioNet. All data collected will be stored in the HtrainDB. I agree to the disclaimer. Media and Photography Notice This is to inform you that H3Africa Administrative Coordinating Centre (H3ACC) will use, exhibit, display, broadcast, and create derivative works of the photographed and/or filmed images taken of H3Africa Consortium Meeting Participants at H3Africa Consortium Meetings. These materials will be used for educational purposes as well as public media, such as, social media forums, as may be deemed appropriate by H3Africa Steering Committee. Participants understand that they may be identifiable from such photographic or electronic reproduction and waive all rights, claims, or interest to control their identity or likeness in whatever media used.