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.

Registered Non-profit Based in AfricaRegistered Non-profit Based Outside Africa

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.

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.

I confirm (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.