Membership Application

Step 1: Personal Information

Full Name (Legal Name) *

Gender (Optional)

Male Female Prefer not to say

Date of Birth

Nationality *

Country of Residence *

City / Region

Email Address *

Phone / WhatsApp Number *

Step 2: Professional Identity

Primary Field (Select all that apply) *

Inventor Innovator Researcher / Academic Scientist / Engineer Thinker / Philosopher Creative (Writer, Artist, Designer, Filmmaker, etc.) Entrepreneur (IP-based) Student / Emerging Intellectual Other:

Area(s) of Expertise or Interest *

Step 3: Intellectual Property & Work

Step 4: Motivation & Values

Why do you want to join the Intellectual Rebirth African Forum? *

How do you believe African intellectual capacity can transform Africa? *

Are you willing to collaborate ethically with other African intellectuals? *

Yes No

Step 5: Membership Criteria

Please confirm the following by ticking each box:

I am African by birth, heritage, or long-term contribution to Africa I am engaged in intellectual, creative, innovative, or research-based work I respect intellectual property rights and originality I am committed to ethical knowledge-sharing and collaboration I support African-led solutions and development I agree not to plagiarize, exploit, or misuse others' intellectual work

Step 6: Membership Type & Declaration

Applying As *

Full Member (Active intellectual / IP holder) Associate Member (Supporter / Collaborator) Student / Emerging Mind Institutional / Collective Representative

Consent & Declaration

I hereby declare that the information provided in this application is true and accurate to the best of my knowledge. I understand that membership in the Intellectual Rebirth African Forum is based on intellectual integrity, ethical conduct, and commitment to Africa's intellectual advancement.

Create Password *

Confirm Password *

I agree to the above declaration and consent to the processing of my application *