This year’s Students and Young Professional African Liberty Academy Seminar will be held at Catholic University in Quelimane,Mozambique from August 1- 8, 2012.

PLEASE FILL OUT THE APPLICATION FORM BELOW BEFORE JULY 05, 2012

About You

 

*Salutation:

 

*First name:

*Middle name:

*Last name:

*Preffered name:

*Date of Birth:

*Gender

*E-mail:

*Country of Citizenship:

 

Contact Information:

Your Permanent Address:

 

*Street:

 

*City:

*Zip/Postal Code:

*Country:

*Phone:

Cell Phone:

 

 

Academic Information:

*Your College/University:

*Major or Graduate Program:

Essay

Mention 5 positive things you would want your government to do for small and medium enterprises. (Essay should not be below or above 100 words).

 

*I agree to adhere to African Liberty.org's Rules during the seminar
Please enter your name:



Note: We will not evaluate incomplete applications.