AVU Membership Application Form

Membership Application Form

The African Virtual University Cape Office Park Ring Road, Kilimani PO Box 25405 - 00603 Nairobi KENYA		L'Université Virtuelle Africaine Sicap Liberté 6 extension VDN villa no 8 B.P. 50609 Dakar SENEGAL
Membership Application Form

Please complete this form and submit it. Your application will be reviewed and you will be duly informed of the outcome. Once this has been accepted, the membership fees must be paid to complete the registration process. See available payment modes on the next page. For more information on AVU Membership, refer to the Terms and Conditions. (Opens PDF Document)

Please Note that Fields marked with (*) are Compulsory
Institution Contact Information:
Full Institution Name:(*)

Please enter the Name of the institution
Type of Institution

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If Other, please Specify

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(Provide copy of registration certificate)(*)

Recognised extensions are .doc, .txt, .pdf, .docx, .tiff, .jpg, .jpeg
Country of Registration(*)

Please select Country of Registration
Billing Address
Physical Address - Street(*)

Please enter the Physical Address - Street
Postal(*)

Please enter the Postal Address
City(*)

Please Enter the name of the City in the correct format
State/Province(*)

Please Enter the State/Provice
Zip Code

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Website

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Contact Email(*)

Please enter Email in correct format
Fax Number(*)

Please enter Fax Number
Telephone(*)

Please enter the Telephone Number
Contact Name (First, Last)(*)

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Title

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Choose Membership Type(*)

Academic Partner
Non-Academic Partner
Please select Membership Type

Academic Partner
Non-Academic Partner
Partnership Level(*)

Please select Partnership Level

Partnership Fees & Benefits
The information provided above will be used only to process your application.

Applicant’s Declaration:
I have read and understood the Terms and Conditions (opens PDF Document). I undertake to abide by the Terms and Conditions and the AVU Charter.
Accept?

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Payment information:

AVU is offering flexible payment options:
1. Online,
2. Direct wire transfer and
3. Cheques

Africa Virtual University - AVU

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