Nominating manager registration form (ALMI Cohort 5) Question Title * 1. Company name Question Title * 2. Website of organisation (if applicable) Question Title * 3. Your name Question Title * 4. Your role in the organisation Question Title * 5. Country of operation Question Title * 6. Focus of operation Urban Rural Both Question Title * 7. Does the majority of your organisation's income come from the sale of products and/or services? Yes No Please provide estimated percentage Question Title * 8. Stage of business Start-up Growing Established Question Title * 9. Sector Manufacturing Transport and Logistics Food and Beverages Technology Retail Other (please specify) Question Title * 10. Years of operation Question Title * 11. Number of full-time employees Question Title * 12. Number of senior managers Question Title * 13. Number of mid-level managers Question Title * 14. Number of staff you want to nominate for the program 1 2 3 4 5 Other (please specify) Question Title * 15. Your professional contact details where you can be reached: Physical address Question Title * 16. Phone number Question Title * 17. E-mail address Question Title * 18. How did you learn about the Amani Managment and Leadership for Impact program? Social Media (Facebook, Twitter, LinkedIn, etc.) Web search Amani Institute website Other website Personal reference (friend, colleague, etc.) Event (Amani info event, taster session, another event) Newsletter (Amani newsletter) Other (please specify) Next