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 )

    Advocacy Contest Application

    Please provide your information below indicating your desire to enter the 2019 Sickle Cell Advocacy Contest.

    I Am Contesting As An*

    First Name: *

    Last Name: *

    Email: *

    Phone: *

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    Twitter Handle

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    Address: *


    City *

    State

    Zip/Postal Code

    Country *

    Did you work with a team?*

    Select the checkbox below if you worked with a team to carry out the advocacy initiative or activity.

    Team Size*

    Organization/Institution Name*

    Address: *


    City *

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    Zip/Postal Code

    Country *

    Twitter Handle

    Instagram Page

    Organization Contact Person
    First Name: *

    Last Name: *

    Email: *

    Phone: *

    please add (+ country code)




    Initiative/Activity Title: *

    Initiative/Activity Theme (If Any)

    Sickle Cell Issue Addressed: *

    Indicate Sickle Cell Issue Addressed Below *

    Summary/Description *

    Briefly describe the advocacy initiative or activity

    Main messages or Recommendations*

    Outline the main messages and/or recommendations conveyed by the advocacy initiative or activity

    Results Achieved *

    What results were achieved through the advocacy initiative or activity?

    Impact of the Initiative/Activity *

    What is the actual or expected impact of the advocacy initiative or activity?




    My Activity/Initiative Has A *

    Twitter Handle


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    Twitter Hashtag


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    Instagram Page


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    Facebook Page


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    Website/Webpage


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    Photo Uploads / Video Link

    Upload your selected photos and/or supply a link to a video coverage about your advocacy/initiative

    Upload Photos

    Size limit: 5mb, Formats: .jpg, .jpeg, .png, .gif

    Link to Video

    Enter url to your advocacy video hosted on either your website, youtube or other video platforms



    By submitting this application, you agree to attend the congress event and consent to the display and usage of your submitted materials for the necessary activities to facilitate the success of this contest.



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    2021 African Congress on Sickle Cell Disease