mpintshi REGISTRATION FORM
mpintshi REGISTRATION FORM
* Required
Personal Details
NAME
*
Your answer
SURNAME
*
Your answer
HOME ADDRESS
*
Your answer
POSTAL CODE
*
Your answer
CONTACT NUMBER:
*
Your answer
PROVINCE
*
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
North West
Northern Cape
Western Cape
You need to be between 18 and 25 years to be a mpintshi
Date Of Birth
*
MM
/
DD
/
YYYY
HOW OLD ARE YOU?
*
Your answer
ARE YOU MALE OR FEMALE?
*
FEMALE
MALE
BACKGROUND
*
EDUCATOR
SPORT COACH
Young Person IN SCHOOL
Young Person NOT IN SCHOOL
OTHER (Specify)
OTHER (Specify)
Your answer
mpintshi (Mp) Pledge
I hereby pledge to commit my service to loveLife for at least one year, I will try, by my actions, to be a positive influence on others I will allow myself to be guided by the loveLife team for my growth and effective implementation of the programme. I promise to remember to live by this pledge, I mean it, I will live and keep it.
Do you Agree
*
Yes
No
Additional Information
If you qualify, would you like to be considered for a gB position in future?
*
Yes
No
Do not qualify
Date
*
MM
/
DD
/
YYYY
Submit
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