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New Member Registration

* If you are an organisation seeking new AFRINIC membership please use this form.

1. General Information

* Organisation Name:
Please fill in with the organisation's legal name
* Activity Area:
* Membership Type: End-User LIR
* General Address:
* City:
Postal Code:
* Country:
* E-mail:
* Phone:
Note: numbers should start with a plus sign, followed *immediately* by the country code and then the national number (single spaces only please!)
e.g. +230 503 4100
Fax:

2. Billing Contact

Check if billing address is same as above
* First Name:
* Last Name:
* Billing Address:
* City:
Postal Code:
* Country:
* E-mail:
* Phone:
Note: numbers should start with a plus sign, followed *immediately* by the country code and then the national number (single spaces only please!)
e.g. +230 503 4100

3. Admin / Tech Contacts

Check if you already have a pre-existing admin nic-hdl
Admin Contact
Admin Nic-hdl:
Please enter your Admin's WHOIS nic-hdl
(Learn How to Create a Nic-hdl)
Admin's First Name:
Admin's Last Name:
Admin's E-mail:
Phone:
Check if you already have a pre-existing tech nic-hdl
Tech Contact
Tech Nic-hdl:
Please enter your Tech's WHOIS nic-hdl
(Learn How to Create a Nic-hdl)
Tech's First Name:
Tech's Last Name:
Tech's E-mail:
Phone:


4. Additional Information

Existing IP addresses:
If you already have IP addresses where did you get them from?
APNIC ARIN RIPE NCC
LACNIC Upstream Provider
* RIR meeting:
Have you attended an RIR meeting?
Yes No
* Training:
When do you plan to train your staff on IP resource management?
Never 1 - 3 months 3 - 6 months 6 - 12 months > 12 months
* Resource Request:
Please indicate which resources you would like to request
ASN PI4PI6PA4PA6