Night of Mentorship and Networking Registration Form


Program Details
Date: March 21, 2020
Time: 5:00 AM to 8:00 PM
Venue: Accra
Cost: 100 GHS per person
Contact: Call, SMS or Whatsapp Selasie Lore +233 24 150 0200 / Augustina +233 24 293 8781 or Henrietta +233 24 541 0621

Please take the time to answer all questions thoughtfully, with enough detail to help us understand who you are. Please keep your replies to 200 words or less per response. We review each application in detail, and we look forward to reading yours!

First Name *
Last Name
How did you hear about the mentorship program ? *
What is your date of birth? *
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what company or organization do you currently work for?
What position do you currently hold in your place of employment?
For how long have you been in this role?
In 200 words or less, please explain why you wish to be part of the mentorship and networking program?
Participation in the Mentorship and Networking program will require you to be available from 5:00PM – 8:00 PM. Would you be able to fully participate?
Clear selection
The program costs GHS100. How do you expect to finance this?
Clear selection
Could you provide email addresses and mobile numbers of up to ten other women in your network that you feel may be interested in receiving information about the mentorship and networking program?
What is your work email address?
What is your mobile phone number?
Kindly provide an alternate email address. ( your personal email address.) *
Submit
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