×
Home
About
Who we are
Leadership
Operational Team
Advisory Board
Projects
Office Space
35 Under 35
Young African Voices
AfriTour Expeditions
HERizon Africa
Network
Summit
Events
Face-to-Face
Annual Summit
Upcoming Events
Repository
Blog
Publication
Gallery
Podcast
Contact Us
Summit Registration Form
Home
Summit Registration Form
1
Personal Information
2
Professional Details
3
Event Activities
Preferred Title
--Select--
Ms
Mrs
Dr
Prof
Hon
Full Name
Nationality
--Select--
Afghan
Albanian
Algerian
Andorran
Angolan
Antiguan and Barbudan
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bhutanese
Bolivian
Bosnian and Herzegovinian
Botswanan
Brazilian
Bruneian
Bulgarian
Burkinabe
Burundian
Cape Verdean
Cambodian
Cameroonian
Canadian
Central African
Chadian
Chilean
Chinese
Colombian
Comorian
Congolese (Democratic Republic)
Congolese (Republic)
Costa Rican
Croatian
Cuban
Cypriot
Czech
Danish
Djiboutian
Dominican
Dominican Republic
East Timorese (Timorese)
Ecuadorian
Egyptian
Salvadoran
Equatorial Guinean
Eritrean
Estonian
Eswatini
Ethiopian
Fijian
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Greek
Grenadian
Guatemalan
Guinean
Guinean-Bissauan
Guyanese
Haitian
Honduran
Hungarian
Icelander
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakhstani
Kenyan
I-Kiribati
Kosovar
Kuwaiti
Kyrgyzstani
Laotian
Latvian
Lebanese
Lesothan
Liberian
Libyan
Liechtensteinian
Lithuanian
Luxembourger
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monegasque
Mongolian
Montenegrin
Moroccan
Mozambican
Myanmarese
Namibian
Nauruan
Nepalese
Dutch (Netherlands)
New Zealander
Nicaraguan
Nigerien
Nigerian
North Korean
North Macedonian
Norwegian
Omani
Pakistani
Palauan
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Filipino
Polish
Portuguese
Qatari
Romanian
Russian
Rwandan
Kittitian and Nevisian
Saint Lucian
Saint Vincent and Grenadinian
Samoan
Sammarinese
São Tomean and Principean
Saudi Arabian
Senegalese
Serbian
Seychellois
Sierra Leonean
Singaporean
Slovak
Slovenian
Solomon Islander
Somali
South African
South Korean
South Sudanese
Spanish
Sri Lankan
Sudanese
Surinamese
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian and Tobagonian
Tunisian
Turkish
Turkmenistani
Tuvaluan
Ugandan
Ukrainian
Emirati (UAE)
British (UK)
American
Uruguayan
Uzbek
Vanuatuan
Vatican City
Venezuelan
Vietnamese
Yemeni
Zambian
Zimbabwean
Country of Residence
--Select--
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Democratic Republic)
Congo (Republic)
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Gender
Email Address
Phone Number
LinkedIn Profile
Next
Organization / Institution
Current Role / Designation
Years of Experience
Sector (Select one):
Government / Public Sector
Private Sector
Development / NGO
Finance / Investment
Media / Communications
Academia / Research
Entrepreneurship / SME
Student / Emerging Leader
Other (please specify)
Other Areas of Expertise
Previous
Next
Event Activities (Optional But Recommended)
Tick All Above You Want To Participate
Cycling Scholars Adventure - Day 1
Host Country Tour (Ghana) - Day 2
Main Summit Conference – Day 3
Participation Category
--Select Registration Type--
Delegate Pass
Executive Pass
Delegate Pass
--Select--
Member (USD 150)
Non-Member (USD 250)
Executive Pass
--Select--
Member (USD 350)
Non-Member (USD 500)
Submit
Thank you for registering to participate in the HERizon Africa Summit. An email will be sent to you shortly in order to proceed with payment.
An error occured.
Previous
The form was sent successfully.
An error occured.
Go Top