1.Designation ( Dr ,Professor, Mr., Mrs. etc )

2.Name; surname first and other name

3.Email address

4.WhatsApp number

5.Occupation and affiliation

6.Country

7.Which of the following working group do you intend to join; 1. Capacity building WG, 2.Stroke service WG, 3. Research WG 4. Collaboration AAE WG

8.Membership fee for persons based in Africa- USD$ 60,
Membership fee for other applicants (International)-USD$100

9.Select method of payment (contact africanstrokeorg@gmail.com to complete payment process, secretary on WhatsApp +233262463986)
1. Online payment (Visa and Master card)
2. Bank transfer

10.Are you a member of any other association or organization ?