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Revive South Sudan Party Prospective Membership Form
This form is for prospective members to register their contact information with the RSSP.
* Indicates required question
Email
*
Record my email address with my response
First Name
*
Your answer
Other Names
*
Your answer
Occupation (Student/Civil servant/Self-Employed, etc)
*
Your answer
Do u have a skill/talent or expertise that you can volunteer full/half time in helping advance the cause for a better South Sudan? (Please specify)
Your answer
State
*
Abyei Administrative
Central Equatoria
Eastern Equatoria
Jonglei State
Lakes State
Northern Bahr el Ghazel
Pibor Adminoistrative Area
Ruweng Adminstratitve
Unity State
Upper Nile
Warrap State
Western Bahr el Ghazel
Western Equatorial
County, Payam, Boma
Your answer
Passport/Nationality ID Number
Your answer
Current Residence (Address)
*
Your answer
Phone number
*
Your answer
I agree that my information may be used by the Revive South Sudan Party for its activities
*
Yes
Any comment, encouragement or question?
Your answer
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