H.E Chief Olusegun Obasanjo
UNDER THE HIGH PATRONAGE OF
HIS EXCELLENCY CHIEF OLUSEGUN OBASANJO GCFR, Ph.D

( Former President of The Federal Republic of Nigeria )

    Africa Hub Application

    The Africa Hub provides an unparalleled oppportunity for Sickle Cell Support Organizations to enhance their organization’s visibility, launch a project, present a workshop, meet donors, rally supporters and prospective partners and/or make a presentation about their community reach or organization


    Please note: Space are not allocated on a first-come, first-served basis and there are a limited number of Africa Hub exhibit spaces available.

    Organization Status

    Organization Status*
    Organizations must be a registered non-profit with a focus on addressing sickle cell in Africa, with proof of past, current or planned projects and a good track record for implementation, measuring outcomes and impact.

    Country of Registration: *

    Registration No: *




    Organization Information

    Organization/Institution Name: *

    Phone: *


    please add (+ country code)

    Email: *

    Address: *

    City *

    State

    Zip/Postal Code

    Country *

    Website

    Organization's Programs and Mission

    Organization's Programs *
    Describe the programs that your organization conducts, oversees, or administers.


    Mission *
    Describe your organization's mission. You can provide your mission statement, founding principles, or goals.


    Awards and Recognition
    List awards, community support, or local government recognition your organization has received.


    Themes

    Organization's Focus*
    Select the themes that best describe the organization's focus area(s).



    Purpose and Goals for Exhibiting

    Purpose and Goals for Exhibiting *
    Describe your organization's purpose for wanting to exhibit at the Africa Hub. You can also provide a bulleted list of goals you want to achieve with your exhibition at ACSCD 2021.




    Exhibit Contact Person

    Person to receive all exhibit correspondence. Please list only ONE exhibit contact person.

    Contact First Name *

    Contact Last Name *

    Phone: *


    please add (+ country code)

    Email: *

    Contact Address

    Complete if different than organization information above.

    Address:

    City

    State

    Zip/Postal Code

    Country




    Authorization

    Please confirm that you have the proper authorization to conduct business relations on behalf of the organization represented here.

    (mandatory)

    Signature *

    Enter your full name in the signature box below to complete confirmation



    By submitting this application, you agree to the terms and conditions for exhibiting at ACSCD 2021.



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    2021 African Congress on Sickle Cell Disease