Acc Stakeholders Platform Registration Form (#35)

Full Name

Gender

Male

Female

Organization/Institution Name

Which category describes you best?

Email address

Phone/Mobile

Country of Departure

If you need a referral visa to enter Tanzania, please provide your passport number to enable us prepare an invitation letter

Preferred language

English

French

Portuguese

Kiswahili

Do you have any disability or impairment that need special arrangement?

Kindly indicate if you will be travelling with a toddler/a minor

Please indicate if you are allergic to certain types of foods/drinks

Preferred payment method of the registration fee

Bank transfer

Western Union or Money Gram

Other Means

Payment details are provided on the concept note.

The requested information herein will be used for the purposes of the organization and managing of the Stakeholders’ Platform only.

Stakeholders Platform Registration Form