APSP Plenary Registration Form

APSP Plenary Africa Registration

Please fill in the form below if you are African currently living on the continent of Africa.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
What location will you be viewing the Plenary from?*
What type of location*

A residence other than my ownPublic Meeting SpaceOther
Please provide the address for this location:
What is the primary language spoken at this location*
Please type in the language spoken at this location.
If this is a group gathering, please attach a list with the names/phone/email of attendees for this location.

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Which days will you participate?

Friday, February 11, 2021Saturday, February 12, 2021Sunday, February 13, 2021Monday, February 14, 2021
Submit Payment *
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General Admission $10.00

Total $0.00
Should be Empty:

APSP Plenary Africa Registration