AFFILIATES APPLICATION FORM – AFRICAN AGRICULTURAL CITIES

AFFILIATES APPLICATION FORM

Step 1 of 5

Name *

First

Last

Name and Surname of individual or Director of company?

Company name if applying on behalf of registered company

Contact Number of Director or Individual

Address where business is located? *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Business Contact No *

Business Website / URL