Delegate Name
*
First Name
Last Name
Parent's Name
*
First Name
Last Name
Telephone (H)
*
Cell
*
Age
13
14
15
16
17
E-mail
*
Birthdate DD-MM-YYYY
*
Address
*
City
*
Postal Code
*
Province
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
School Name
*
Grade
*
T-Shirt Size
Select Size
Small
Medium
Large
X-Large
Upload headshot
*
Upload your headshot
Supported files:: All format
Cancel
of
Volunteer Work
*
Country Representing
*
------African
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad, Comoros
Cote d'Ivoire
Democratic Republic of Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Republic of Congo
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
South Sudan
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
------Caribbean
Antigua and Barbuda
The Bahamas
Barbados
Cuba
Dominica
Dominican Republic
Grenada
Haiti
Jamaica
St. Kitts and Nevis
St. Lucia
St. Vincent and the Grenadines
Trinidad and Tobago
If you have a platform, provide a brief description.
*
Mandatory
*
I have read and understand the Rules and Regulations
Save
Submit Form
Clear Form
Print Form
Should be Empty: