New Customer Registration Form

1
Full Name* This field is required.
Prefix
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
Occupation * This field is required.(what you do for living)
eg. lotto agent
4
Where are you from? (Town)
eg. Ayi Mensah
5
NB: YOU ARE TO MAKE PAYMENT FOR ANY OF

THE GROUPS OF YOUR CHOICE BEFORE YOU WILL

BE GIVEN YOUR FIRST WIN TWO DIRECT AND

AFTER PAYMENT, CALL THE NUMBER YOU MAKE

THE PAYMENT TO FOR CONFIRMATION !!!
6
Which of the groups do you prefer?
General -- 1000GH¢ renewable after 1 month
VIP -- 5000GH¢ renewable after 1 year
7
MAKE YOUR MoMo PAYMENT TO

+233 (0) 24 796 7372
8
Date
dd-mm-yyyy
Year
Month
Day
9
How did you hear about us?
eg. friends /social media/TV/radio....
10
Declaration
By clicking this, I have read, understood and agreed on the PRIVACY POLICY as far as the terms and conditions of NLA GAMES ARE CONCERN.
Should be Empty: