Midlands STEM Leadership and Strategy Symposium
Delegate Registration
Delegate Registration Form
Event Dates: 23–25 July 2025. Location: Midlands State University, Gweru, Zimbabwe. Thank you for your interest in participating as a delegate at the Midlands STEM Leadership and Strategy Symposium. This event represents a groundbreaking collaboration between Midlands State University (MSU) and Nelson Mandela University (NMU) to address regional STEM education challenges and foster strategic partnerships to prepare the SADC region for the 4th Industrial Revolution. Kindly fill in the form below to confirm your participation and provide the necessary details to assist in planning and logistics.
Section 1: Personal Information
Full Name
*
Type in your name.
Title or Position
*
Type in your title or position.
Organization/Institution
*
Type in your Organization/Institution
Country
*
Type in your Country.
Email Address
*
Type in your email.
Phone Number (including country code)
*
Type in your Phone Number including country code.
Assistant/Contact Person (if applicable)
Type in your Assistant/Contact Person (if applicable).
Contact Email (if different)
Type in your Assistant/Contact Person Email (if applicable).
Section 2: Participation Type
Will you be attending the full symposium?
*
Please Select
Yes
Selected Days
Still Deciding
If Not, which days will you be attending?
*
Please Select
Wednesday
Thursday
Friday
Training Only
Do you wish to attend the 6 Day Training session after the symposium?
*
Please Select
Yes
No
View Course Structure & Catalogue for Details
Would you wish to attend with someone else?
Please Select
Yes i would wish to bring in some one
No, i will be attending by myself
If yes, share the details of the members?
Street Address Line 2
City
Postal / Zip Code
Are you interested in participating in breakout sessions? (Select one)?
*
Please Select
Yes
No
Do you require special accommodations? (e.g., dietary restrictions, mobility assistance)?
Street Address Line 2
City
Postal / Zip Code
Section 3: Networking and Collaboration
Are you open to networking with other delegates, exhibitors and speakers?
*
Street Address Line 2
City
Postal / Zip Code
Would you like to showcase any projects or initiatives during the networking session?
Please Select
Yes
No
If yes, please provide a brief description of the project/initiative:
(e.g., STEM for socio-economic development, 4th Industrial Revolution, education technology, innovation strategies, etc.)
Street Address Line 2
City
Postal / Zip Code
Are you open to participating in panel discussions, workshops, or breakout sessions during the event?
Please Select
Yes
No
Would you wish an extended engagement with Policy Makers
Please Select
Yes
No
eg Ministers, University Leadership
Are you open for a brief tour of local nearby schools or correctional facilities?
Please Select
Yes
No
How interested are you in taking an extended tour of local hospitality sites?
Please Select
a) Yes, I would love to take the tour.
b) No, I'm not interested in taking the tour.
c) Maybe, depending on the schedule and details.
Section 4: Media Engagement & Permissions
Are you willing to be interviewed by local and international media covering the conference?
Please Select
Yes
No
If Others, please specify
May we record and share your any presentation of featuring you may participate in?
*
Please Select
Yes
No
If Others, please specify
Do you consent to your profile being featured in the event materials?
*
Please Select
Yes
No
If Others, please specify
Section 5: Logistics
TRAVEL REQUIREMENTS
Will you need assistance with travel arrangements?
*
Please Select
Yes
No
If Others, please specify
Preferred Arrival Date:
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-
Month
-
Day
Year
Date
Preferred Departure Date:
*
-
Month
-
Day
Year
Date
ACCOMMODATION REQUIREMENTS
Will you need assistance with accommodation arrangements?
*
Please Select
Yes
No
If Others, please specify
Additional Needs
(dietary restrictions, mobility assistance, etc.)
Section 6: Suggestions or Additional Contributions
Do you have any suggestions to enhance the conference? (Optional)
(Please specify any ideas, speakers, exhibitors, or topics you'd like to suggest)
Section 7: Terms and Conditions
By submitting this form, I confirm my intent to participate as a Keynote Speaker at the Midlands STEM Leadership and Strategy Forum. I understand that my presentation will contribute to shaping actionable strategies for local STEM education and innovation across Zimbabwe and beyond
Submit Application
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