Not able to submit Connect Live 2019 application

The image below is the screenshot of what happened to me after I submitted the application, does anyone face the same issue? I filled up all the fields and I am confident that all links/info are correct. I have also tried it with different browsers/devices but the results is the same, could someone help?

Could someone form the Google Moderator team solve this issue? @GeorgesHR, @KlaudiyaG, @VasT