Testing Form - Youth Party - Join the movement let us Shape the Future together

MEMBERSHIP FORM

Last Name First Name Email Phone Number State of Residence LGA of Residence State of Origin LGA of Origin Profession Employment Status Name of Organisation Date of Birth Gender Male Female Contact Address How did you find out about Youth Party? Existing Member Social Media Other Tick the statement that applies to you: I am enrolled on the INEC Voters Register at my Contact Address as shown above and I possess a valid Permanent Voter Card (PVC).
I am not currently enrolled on the INEC Voters Register and I do not have a Permanent Voter Card.
Reason Monthly Membership Dues (₦1,000)

You are welcome to pay for as many months in advance as you prefer. Thank you for your continued support.

I will abide by the rules and regulations of the party; I consent to my details being included in the application for registration as YOUTH PARTY and to being contacted for any other information about my membership.

MEMBERSHIP FORM

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