Personal Information - ICPA 2026

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Personal Information

Please complete the information below, then click Next to continue.

* First name

* Last name

* Email address

* Organisation/Workplace

* Job Title

* Contact Telephone No.

* Registration Type

Have you previously attended an ACPME Conference?

Yes
No

Invoice Address

* Address 1

Address 2

* Country/Region

* City

* State/Province

* ZIP/Postal code

Purchase Order (if applicable)

Please provide details of any medical requirements or special dietary requirements (vegetarian, gluten-free, diary-free, etc)

Please tick here if you DO NOT wish to appear on the delegate list. This will be visible to delegates, exhibitors and sponsors on the Conference app. Only your name, job title and organisation/workplace will be listed.

I DO NOT WISH TO APPEAR ON THE DELEGATE LIST

Next of Kin: Please provide details in case of an emergency during the event

Name of next of kin:

Their contact telephone number:

Please specify their relationship to you:

We will use the information you have provided to process your booking. We are using Cvent to process your registration, by submitting this form, you acknowledge that the information you provide will be transferred to Cvent for processing in accordance with their Privacy Policy and Terms.

I consent to my information being processed in accordance with these terms.

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