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National delegates registration
Please fill in the registration form below.
Title / Titre
*
Mr.
Mrs.
Ms.
Hon.
Prof.
Dr.
Surname / Nom de famille
*
Given Names / Prénoms
*
Email / E-mail
*
Phone Number / Numéro de téléphone
*
Nationality / Nationalité
*
Angola
Benin
Burundi
Cameroon
Central Africa
Congo Brazzaville
Cote D'Ivoire
Ethiopia
Gabon
Ghana
Guinea Con
Equatorial Guinea
Kenya
Liberia
Madagascar
Malawi
Nigeria
Congo, The Democratic Republic of the
Rwanda
Sierra Leone
Tanzania, United Republic of
Togo
Uganda
Zambia
Togo
Zimbabwe
Gender / Genre
*
Male
Female
Passport Size Photo / Photo format passeport
*
National ID Number/ NIN
*
National ID Copy / National ID
*
Company Name / Nom de company
*
Position at the company / poste dans le ntreprise
*
Country of residence / Pays de résidence
*
Angola
Benin
Burundi
Cameroon
Central Africa
Congo Brazzaville
Cote D'Ivoire
Ethiopia
Gabon
Ghana
Guinea Con
Equatorial Guinea
Kenya
Liberia
Madagascar
Malawi
Nigeria
Congo, The Democratic Republic of the
Rwanda
Sierra Leone
Tanzania, United Republic of
Togo
Uganda
Zambia
Togo
Zimbabwe
City of residence / ville de résidence
*
Emergency Contact / Toute information supplémentaire
*
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