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THE ASSOCIATION OF AGRIPRENEURS FOR DEVELOPMENT
MEMBERSHIP REGISTRATION FORM
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* Indicates required question
Email
*
Your email
First & Last Names (Prenom et Nom)
*
Your answer
Gender (Sexe)
*
Female
Male
Date of Birth (Date de Naissance)
*
MM
/
DD
/
YYYY
Which country are you currently residing in? (Dans quel pays residez vous presentement?)
*
Your answer
Full Address (Addresse Complet)
*
Your answer
Phone number (Numero du portable)
*
Your answer
What are your expectations from Agri4Dev? (Quelles sont vos attentes de AGRI4DEV?)
*
Your answer
What contribution will you be making to Agri4Dev? (Quelle contribution envisagez vous pour Agri4Dev?)
*
Your answer
Are you willing to pay an annual Membership fee of 10$? (Etes-vous prêt à payer un frais d'adhésion de 10$, pour 12mois?)
Yes
No
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If you have answered "yes" above, we welcome you to send an interac to
info@agri4dev.org
; This gives you a right to vote! (Si vous avez repondu "oui" si-haut, nous vous invitons à faire un transfert par interac à
info@agri4dev.org
; Cela vous donne de droit de vote!)
Your answer
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