Register: Young African Women Congress 2023 – East Africa

Name

STEP 1
General Information

Title *

First Name *

Last Name *

Other Names

Date of Birth *

Place of Birth *

Nationality *

Country of Residence *

Contact Details

Primary Phone Number: *

Second Phone Number:

WhatsApp Number:

Twitter Account/Handle (@):

Facebook ID:

Email Address *

Address

City

Country *

STEP 2
Education and Languages

Highest Level of Education: *

Course of Study: *

Name of Institution: *

Year of Completion: *

Are you Currently Enrolled in the School/ College/University: *

Yes No

English Language Proficiency: *

Basic Intermediate Advanced

Other Languages Spoken:

STEP 3
Employment/ Professional Experience

Employment Status

Internship

Volunteer

Employee

Self-Employed

Name of Company/Organisation

Position Title/Rank:

Corporate or Official Address:

STEP 4
Group Discussion Session Selection

Please select two groups. Read the descriptions of each group carefully before making your selection *

GROUP ONE (1) - Women in Politics

GROUP TWO (2) – Women in Entrepreneurship

GROUP THREE (3) – Women and Climate Change

GROUP FOUR (4) – Sexual Harassment at the workplace

GROUP FIVE (5) - Conflict Management, Peace and Consensus Building

STEP 5
Parallel Section Selection

List of tracks representing the various topics that would be discussed during the parallel sessions is outlined and each applicant is expected to select at most, two tracks that they would want to join in. *

Track 1: Politics/Leadership

Track 2: Business and Commerce

Track 3: Social Inclusion/Intervention Projects

Track 4: Sexual Harassment and Teenage Pregnancy

Track 5: Education and Training

Track 6: Communication/Media

STEP 6
Supplemental Questions

Responses to these questions are optional. No selections will be made based on this information. This information is used to better understand the people we are dealing with. The aggregate information collected through this form will be kept private and confidential.

Marital Status

Married Single Divorced

Religious Affiliation

Disability

Yes No

Other Leadership Courses - Have you previously participated in a leadership or women empowerment course or training or conference?

Yes

Are you a member of the YAWC Network

Yes

How did you learn about ExLA Group and Young African Women Congress?

Social Media & Online Ads

Newspaper & Print

Website

Friend or Referral

Partner Organizations & Media Houses

Street Billboards

Recommend this congress to a Friend

Full Name

Email Address

Telephone Number

Consent and Commitment
Agree to continue

In order to participate in the ExLA Group Gender Programme’s Young African Women Congress, I understand that I must meet the minimum eligibility requirements for admission to the programme, that I must pay the required registration fees, that I must meet the qualifications standards for the specific group that I have chosen, that I must be a young woman within age 18 – 45, and that my admission to the programme is subject to the determination by the Selection panel. I have read, understood, and will comply with the terms and conditions of the congress. I hereby certify that I have completed this application fully and accurately to the best of my knowledge. I understand that any falsification, omission, or concealment of material fact may subject me to disqualification

AG1

I hereby acknowledge that if accepted as a participant in the Young African Women Congress 2022, I confirm that I will abide by the time commitment as outlined in the full 5 Day programme.

Register: Young African Women Congress 2023 – East Africa

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Register: Young African Women Congress 2023 – East Africa

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