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Membership Application Form
1
Personal Information
2
Delegate Participation
3
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Other Category
Next
How would you like to participate in the Summit?
Core Delegate
Executive Delegate
Honorary Guest
Partner / Sponsor
How would you like to participate in the Summit?
What are your key areas of interest?
Women’s Leadership & Governance
Economic Empowerment & Entrepreneurship
Education, Youth & Innovation
Climate Action & Sustainability
Arts, Culture & Heritage
Technology & Digital Transformation
Health & Wellbeing
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Would you like to participate in the Cycling Scholars Adventure?
YES
NO
(Note: Participation fees go directly to supporting educational initiatives through the Cycling Scholars Foundation)
Would you like to join the Host Country Tour?
YES
NO
(Optional cultural and development-focused experience.)
Are you interested in exhibiting or showcasing your work during the Arts, Exhibition & Auctioning segment?
YES
NO
Describe Your Proposed Exhibition/artwork
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Membership Status:
Please indicate your current affiliation with the HERizon Africa Network.
I am a Registered Member
Non-Member Delegate
Participation Fees (Host-Country Based):
For Network Members
Core Delegates – USD 230
Executive Delegate – USD 450
For Non-Members (Delegates)
Core Delegates – USD 90
Executive Delegate – USD 180
Participation Fees (Foreign Delegates):
For Network Members:
Core Delegates – USD 150
Executive Delegate – USD 250
For Non-Members (Delegates)
Core Delegates – USD 90
Executive Delegate – USD 180
Payment Method
Bank Transfer
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