Africans Rising Membership Form
Email address *
Joining as an *
First Name/s *
Surname *
Name of Organisation
(if applicable)
Date of Birth *
This information will only be used to gather age related membership statistics
WhatsApp Number
Those with severe privacy concerns should not use their personal phone number
Gender *
Region *
Nationality *
Areas of Focus
Tick all areas of focus that apply to you or your organisation
Type of Organisation
(if applicable)
Number of Members in Organisation
(if applicable)
(if applicable)
Membership Declaration
This declaration applies to affiliated organisations, associated individuals and movement supporters.

I have read and I abide by the Africans Rising founding document; The Kilimanjaro Declaration.

I have read and abide by the Africans Rising code of conduct.

I am the authorised representative of the organisation that I am signing up.

I accept to receive newsletters and emails from Africans Rising.

My organisation also agrees to be listed on the Africans Rising website and other materials as a member of the Movement.

I confirm agreement with the all of the above *
Never submit passwords through Google Forms.
This form was created inside of Africans Rising.