Africa Emerging Leaders Conference 2016, Application Form
Dear Applicant,

Kindly fill out this form correctly. Your entries will be subject to evaluation by a selection team.

The conference is open to participants 16-30 years. The conference fee is KSHS 4,500 or 45USD

WYA Africa Team.

First Name: *
Your answer
Last Name: *
Your answer
Other Name (s):
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Correct order of names, to appear on certificate: *
Your answer
Gender: *
Required
Date of Birth: *
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Country of Residence: *
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Nationality: *
Your answer
Document Type: *
Document Number: *
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City/Town or specific address: *
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Email Address: *
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Mobile/Cell Phone: *
Example +254 xxx xxx xxx
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Current Occupation: *
Write "student" is still in school. If working, include the company/firm/organisation and present position
Your answer
Current School/ College/University (if student):
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Do you have any dietary/food restriction/allergy? *
Is so, please describe it, including possible reactions.
Your answer
Do you have any special medication you are taking? *
Is so, please describe it, including possible reactions.
Your answer
Do you have any diability? *
Is so, briefly describe this
Your answer
Do you have membership/affiliation with other organisations? *
Is so, list the organisations
Your answer
Have you completed the WYA Certified Training Program? *
WYA offers the Certified Training Program (CTP). Details available: https://www.wya.net/programs/ctp/
Which WYA events have you participated in? *
In you have not attended any WYA events, state "none".
Your answer
Why do you want to attend the Emerging Leaders Conference? *
Your answer
What are your expectations from this conference? *
Briefly state any expectations you might have.
Your answer
We will be having an Arts Forum on Saturday 12th November 2016, will you be willing to attend ? *
It’s Kes 250/USD 2.50 for conference attendees, payable at the conference.
What is your command of English? *
The conference will be conducted in English.
How did you know about World Youth Alliance?
Your answer
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