Membership Registration

Employee ID

Firstname

Lastname

Othername

Date of Birth

Gender ..Select Gender.. Male Female

Contact

Hometown

Marital Status ..Select Marital Status.. Single Married Divorced Widow(er)

Spouse Name

Management Unit

District

Address of Present Station

Father's Name

Mother's Name

Name

Contact

Relation ..Select Relationship.. Father Mother Husband Wife Nephew Niece Grandfather Grandmother Uncle Aunty Brother Sister Daughter Son Cousin Friend

Address

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