Pan-African Youth Summit On-Site Registration Form

Full Name *

Email: *

Organization/School *

City *

State *

Country *

Please check which days you are interested in attending: *

All	Day 1 (Feb. 23): Education and the Arts
Day 2 (Feb. 24): Political Economy	Day 3 (Feb. 25): Health and Nutrition
Day 4 (Feb. 26) : Gender Roles and the African Family	Day 5 (Feb. 27): Spirituality
Day 6 (Feb. 28): Final Day (culmination of all day's events)

Please list any special needs: