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2021 Member Nation Registration Form
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2021 Member Nation Registration Form
Step 1 of 2
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This form requires you to provide detailed information necessary to register a team for the JA Africa Company of the Year Competition. Please ensure you complete all sections of the form.
Basic Information
JA Office Name
*
COY Contact Person for Member Nation
*
Full Name
Job Title
Mobile Phone (include country code)
Email Address
Executive Director Information
*
Full Name
Email
Mobile # (include country code)
Gender
*
Male
Female
Chaperone Information
*
Full Name
Email
Mobile # (include country code)
Gender
*
Male
Female
Date of Birth
*
Team Information
*
Team Name
Team Email
School Name
Please note that you may only list a maximum of 4 students. The information requested below must be provided for each student.
Student 1
*
Full Name
Gender
Date of Birth
*
Emergency Contact Name
Address
Phone Number
Student 2
*
Full Name
Gender
Date of Birth
*
Emergency Contact Name
Address
Phone Number
Student 3
*
Full Name
Gender
Date of Birth
*
Emergency Contact Name
Address
Phone Number
Student 4
*
Full Name
Gender
Date of Birth
*
Emergency Contact Name
Address
Phone Number
Uploads
JA Africa reserves the right to remove an uploaded document if the quality of the document is unacceptable or if a virus is detected.
UPLOAD ALL PHOTOGRAPH RELEASE, PARENTAL CONSENT & CHAPERONE CONDUCT FORMS
*
Drop files here or
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