AFRICAN FAMILY INDUCTION

AFRICAN FAMILY INDUCTION INTEREST FORM

Please use this form to confirm your interest to participate in the African Family Induction Ceremony
Complete the nomination form in its entirety and return by email to: goodwillawards@gmail.com or mail to: African Focus Inc. P.O. Box 11091, Carson, CA 90749
For more information, visit our website at: www.africanfocus.org and www.africangoodwillawardsandinduction.com for pictures from past events

Candidate Information

Name

Address

Phone Number

(###)

###

####

Email Address

Contact Person & Number

African Family Induction Participating Countries:

Please indicate at least 2 countries of interest by select 1 and or 2 in the checkbox next to the country of choice.

African Family Induction Participating Countries

Option Cameroon

Option Uganda

Option Ghana

Option Zambia

Option Liberia

Option Senegal

Option Nigeria

Option Kenya

Option Other Countries of choice

If select other country, please specify country name

Nominator Information (if different from participant)

Name

Phone Number

(###)

###

####

Email Address

Optional: (please provide additional information if any that you want to share with us)

Please contact Paul Babatunde at goodwillawards@gmail.com with any questions.

Signature of Content and Submittal Agreement

Applicants, by signing below affirm that the information provided in this application is true and agree that any false information provided in any part of this application shall constitute a reason for denial of application and participation in the Induction.

Applicant signature: ____________________________________ Date: _________________

Electronic signature accepted