Diversity in ICT Program - AFRINIC Forms Platforms

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Diversity in ICT Program Request Form

Section A: ABOUT THE APPLICANT

First Name(*)

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Surname(*)

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Email(*)

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Preferred Phone No(*)

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Position(*)

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Section B: ABOUT THE ORGANISER

Organisation Name(*)

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Organisation Webpage

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Organisation phone number(*)

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Organisation Email(*)

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Section C: ABOUT THE EVENT/PROJECT

Event Name(*)

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Start Date (mm/dd/yyyy)(*)

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End Date (mm/dd/yyyy)(*)

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Location(*)

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Country(*)

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Event/Project Description

Please tell us what your event is about(*)

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Targeted Audience

Please tell us who this event or project is targeting(*)

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Number of beneficiaries of this event/project

Number people will be impacted by the benefits of this event or project(*)

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Event Occurrence

What is the occurrence frequency of the event(*)

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Scope of the Event

Please specify the territory of the event (*)

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