MEMBERSHIP RECRUITMENT FORM

Surname:

Other Name:

ID/Passport No:

Email:

Party Membership No: This is your Member Number that will be used to complete your registration.

Your Mobile No: Please enter the number with country code. e.g., +254XXXXXXXXX

Date of Birth:

Postal Address:

Sex:

Ethnicity:

Are you a PWD? *

Yes

NCPWD Number

Religion:

Your County?

Your Constituency?

Your Ward?

Enlisting Date

Special Interest Groups:

Youth (Below 35 Years)

Women

Minority Groups

Marginalized Groups

I do hereby affirm/declare/confirm/verify that I am not a registered member of any other registered political party in Kenya. *

Agree with Privacy Policy, Terms and Conditions. *

Note: I accept to provide my personal details below and confirm that the information I enter is correct and accurate to the best of my knowledge. I authorize the Registrar of Political Parties to record my membership in the Green African Party as per Section 34(da) of the Political Parties Act, 2011.

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