APWiL In-Person Summit Registration Title * Please select one of the dropdown optionsProfessorDrMrMrsMs First name * Last Name * Name * (As you wish it to appear on your name badge) Please share a short bio * Limit your bio to max. 200 words Please share a headshot which will appear in the program * Drop a file here or click to upload Choose File Maximum file size: 516MB APRU Member (University) * Position (University role) * Primary email address * Email address(es) to be copied in (if any) Phone number (include country code) Emergency contact person * Email or Phone number * Which APWiL mentoring program did you participate on? * Please select one of the dropdown optionsAPWiL Mentoring Program Pilot (2020)APWiL Mentoring Program 2nd Cohort (2021)APWiL Mentoring Program 3rd Cohort (2022)APWiL Mentoring Program 4th Cohort (2023)Other Which APWiL mentoring program did you participate on? You participated as: * Please select one of the dropdown optionsMentorMenteeOther You participated as: Please share if you have any special needs that you would like to be accommodated? Would you like to request an invitation letter for your visa application? * Yes No Please provide your passport # Will you join the Welcome Reception Dinner on June 22? * Yes No Please share if you have any dietary requirements? Please share further information, if needed If you are human, leave this field blank. Submit
