ADCC Membership Form

Full Name*

Email Address*

Website Address (if applicable)

Phone Number (optional)

Country / Region*

City / State / Province*

Occupation / Profession

Organization (if applicable)

LinkedIn or Social Handle

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Engagement & Interests (Select all that apply)
Investment OpportunitiesTrade & InfrastructureCultural Exchange & Diaspora EngagementAgriculture & Food SecurityEducation & TrainingPolicy & AdvocacyGlobal Affiliate NetworkNetworking & EventsVolunteering / MentorshipBusiness PartnershipsInvestment & FinanceAdvocacy & AwarenessDual CitizenshipOther

If Other, please specify:

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Industry / Sector (Select all that apply)
AgricultureInfrastructureFinanceTradeTechnologyHealthEducationArts & CultureGovernmentOther

If Other, please specify:

Signature (type full name)

Date (MM-DD-YYYY)

Consent & Agreement
I agree to receive communications from ADCC.I confirm that the information provided is accurate.