Call for Participation Registration

Participation Registration Form

Surname *

Other Names *

Gender *MaleFemale

Email Address *

Phone number *

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Emergency Contact Name

Emergency Contact Telephone Number

Nationality *

Passport Number *

Date of birth *

Month *

Day *

Year *

Country of Residence *

Are you a person living with disability? *YesNo

Describe the nature of your disability.

Have you been elected for political office? i.e served in a political position? If yes, please elaborate. *YesNo

Language and skills

English Comprehension and reading *

French comprehension and reading *

Preferred AccommodationSingle OccupancyShared

Education Background

Highest education level *

Name of highest education institution attended together with the year attended. *

List any current memberships or affiliations to professional bodies, community associations or citizen networks that you have in relation to the sub-thematic area of choice

Preferred Committee

Leadership and volunteerism

List any voluntary or leadership experience that you have participated in. *

Demonstrate an instance on how your leadership, innovation and advocacy skills led to achievement of a successful outcome, ideally related to the sub-thematic area of your choice

What knowledge and skills do you hope to acquire from the Pan African Youth Convention

What skills and knowledge will other participants gain from your participation in this program that will better their work? Kindly elaborate

Conference Fee

a) International Delegates

A subsidized fee of Five Hundred and Fifty USD ($550) that will cover 4 day conferencing and networking sessions including keynote speeches with 5 nights 4-Star hotel full board accommodation.

b) Local Delegates

A subsidized fee of Kshs 47,000 for the 4 day conferencing and networking sessions including keynote addresses with 4-Star hotel full board accommodation.