Membership Signup Form - Nourishing Africa

Membership Registration

Join the Nourishing Africa Hub

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Do you own/run an agri-food business in Africa?

Yes No

Has the business been in operation for at least 6 months?

Yes No

Do you have a functional and up-to-date website or an active social media page dedicated to your agri-food business?

Yes No

Personal Information Company General Information Company Contact Information

Fields with asterisk (*) are required

Full Name *

Personal Email *

Date of birth *

Mobile Number

Primary Country *

Gender *

Fields with asterisk (*) are required

Company Name *

Company Designation *

Is your company legally registered?*

Company Stage*

Number of employees*

Keywords *(Add a comma[,] after each tag.)

Company Focus Area *

Company Description *(Minimum of 10 words and a maximum of 100 words)

Fields with asterisk (*) are required

You are required to fill in at least one of either your functional website or valid company social media links. If you have them all, do fill them all in as they help showcase more about your business

Your official email address*

Company Website

Company Logo/Founder's Image*(Maximum file size of 2 MB)

Create Password *

Confirm Password *

How did you hear about us?*

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