We Are Family Association -Member Registration Form

We Are Family Association -Member Registration Form
Personal information
Member's current picture*

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Name*

First NameMiddle NameLast Name
Email
example@example.com
Date Of Birth*

DayMonthYear
Date
Gender*

MaleFemale
National ID Number
Passport Number
Passport/National ID front Picture*

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Passport/National ID Back Picuture*

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Phone Number*

Area CodePhone Number
Other Phone Number

Area CodePhone Number
Marital Status*

Singlemarriedothers

RESIDENCE INFORMATION
CURRENT ADDRESS

Street Address/ADDRESS NAME

Street Address Line 2/PARISH

City/SUB-COUNTYState / Province/REGION

Postal / DISTRCITCountry
HOME ADDRESS(where you stay in uganda)*

DISTRICT

SUB-COUNTY/DIVISION

PARISH VILLAGE

ADDRESS NAME
ANCESTRAL HOME(your burial place)*

DISTRICT

SUB-COUNTY/DIVISION

PARISH VILLAGE

ADDRESS NAME

FAMILY INFORMATION
SPOUSE'S INFORMATION( Husband/Wife)

CHILDREN INFORMATION

NEXT OF KIN

Please provie the contact details of your next of kin .This will help us reach your designated person in case of an emergency
Name*

First NameMiddle NameLast Name
Relationship *
Phone Number*
Please enter a valid phone number.
OTHER Phone Number
Please enter a valid phone number.
National ID Number/Passport*
Address*

ADDRESS

VILLAGE

PARISHSUB-COUNTY

DISTRICTCountry

PERSONAL MENTORS

These are people that are the most important in your life
1ST MENTOR
Name*

First NameMiddle NameLast Name
Relationship *
Phone Number*
Please enter a valid phone number.
Other Phone Number*
Please enter a valid phone number.
National ID Number/Passport Number*
Address*

DISTRICT

SUB-COUNTY/DIVSION

PARISH VILLAGE

ADDRESS NAME
2ND MENTOR
Name*

First NameMiddle NameLast Name
Relationship *
Phone Number*
Please enter a valid phone number.
Other Phone Number*
Please enter a valid phone number.
Other number *
National ID Number/Passport Number*
Address*

DISTRICT

SUB-COUNTY/DIVSION

PARISH VILLAGE

ADDRESS NAME

CONFIRMATION AND CONSENT

Verify your information below
''I confirm that the information provided in this form is true and complete to the best of my knowledge .I understand that this information will be used by the assiocation for offical records and future communication .I give my full consent to store and use this data for internal and offical use only ''
DO YOU CONFIRM AND GIVE YOUR CONSENT*

YES
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