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Registration
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*
" indicates required fields
1) Personal Information
Name
*
First
Middle
Last
Full Name
*
(as it will appear on a Certificate)
Date of birth
*
Month
Day
Year
Gender
*
Male
Female
2) Contact Information
Personal contact number
*
WhatsApp Number
Email
*
Enter Email
Confirm Email
Name of Guardian
Emergency contact of Guardian
*
Relationship with Guardian
*
3) Country Information
Country of residence
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Nationality
*
Afghan
Albanian
Algerian
American
Andorran
Angolan
Anguillan
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bermudian
Bhutanese
Bolivian
Botswanan
Brazilian
British
British Virgin Islander
Bruneian
Bulgarian
Burkinan
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Cayman Islander
Central African
Chadian
Chilean
Chinese
Citizen of Antigua and Barbuda
Citizen of Bosnia and Herzegovina
Citizen of Guinea-Bissau
Citizen of Kiribati
Citizen of Seychelles
Citizen of the Dominican Republic
Citizen of Vanuatu
Colombian
Comoran
Congolese (Congo)
Congolese (DRC)
Cook Islander
Costa Rican
Croatian
Cuban
Cymraes
Cymro
Cypriot
Czech
Danish
Djiboutian
Dominican
Dutch
East Timorese
Ecuadorean
Egyptian
Emirati
English
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Faroese
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Gibraltarian
Greek
Greenlandic
Grenadian
Guamanian
Guatemalan
Guinean
Guyanese
Haitian
Honduran
Hong Konger
Hungarian
Icelandic
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakh
Kenyan
Kittitian
Kosovan
Kuwaiti
Kyrgyz
Lao
Latvian
Lebanese
Liberian
Libyan
Liechtenstein citizen
Lithuanian
Luxembourger
Macanese
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Martiniquais
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monegasque
Mongolian
Montenegrin
Montserratian
Moroccan
Mosotho
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Nicaraguan
Nigerian
Nigerien
Niuean
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Palestinian
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Pitcairn Islander
Polish
Portuguese
Prydeinig
Puerto Rican
Qatari
Romanian
Russian
Rwandan
Salvadorean
Sammarinese
Samoan
Sao Tomean
Saudi Arabian
Scottish
Senegalese
Serbian
Sierra Leonean
Singaporean
Slovak
Slovenian
Solomon Islander
Somali
South African
South Korean
South Sudanese
Spanish
Sri Lankan
St Helenian
St Lucian
Stateless
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian
Tristanian
Tunisian
Turkish
Turkmen
Turks and Caicos Islander
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbek
Vatican citizen
Venezuelan
Vietnamese
Vincentian
Wallisian
Welsh
Yemeni
Zambian
Zimbabwean
Passport Number
4) Educational Background
Are you a Student or Worker?
*
Student
Worker
If student, program of study
*
If worker, Field of expertise
*
Current institution
5) Personal Health Information
Have you been vaccinated with COVID vaccine?
*
Yes
No
Do you have a Physical / Dietary Need?
I have a Physical Need
I have a Dietary Need
Select All
Provide detials of your Need
*
Are you coming with a partner?
Yes
No
What is your Mother Tongue?
*
Partner Name
6) Conference required information
Preferred PANEL/FORUM
*
Media, Digitization, Technology and CyberSecurity (MDTC)
Governance, Advocacy, Education, Politics and Public Institutionalization (GAEPP)
Natural Resource Management and Climate Change. (NRMCC)
Trade, Entrepreneurship and Agriculture (TEA)
Health and sanitation (HS)
(Five working groups labelled PANELS/FORUM would deliberate on specific topics relevant to real challenges in Africa. Participants would then come up with recommendations and implementation plans for practical results.)
How would you like to participate?
*
Physical Participation (Inperson)
Virtual Participation (Online)
Size of T-shirt
*
Small - S
Medium - M
Large - L
Extra Large - XL
Extra Extra Large - XXL
Other
How did you hear about Change Africa?
*
Family/Friends
Facebook
Instagram
Google Search
Physical poster/flyer
IYDC Alumni
BTN Africa
10Times
Tell us your expectations
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