APWiL In-Person Summit

Title

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

Maximum upload 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? Which APWiL mentoring program did you participate on?

You participated as: 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