Nigerian Youth Compact on COVID-19
INDIVIDUAL MEMBERSHIP FORM
Email address *
Name (Surname) *
Staete of Residence Contact Address *
Telephone Number *
Date Of Birth
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/
DD
/
YYYY
Gender
Clear selection
State of Origin
LGA
Do you belong to any Youth Organization?
If 'Yes' what the name of the Organization?
Contact Address of the Organization
Organization Official Email
Phone Number
Name of Contact person
Do you have a Voter Card?
Clear selection
Have you voted before?
Clear selection
Do you have an idea of what covid-19 is all about?
Have you been in leadership position before?
Would you want to participate in our Students Enlightenment Program?
Clear selection
How did you obtain information about the program?
facebook
Advert
Referral
Email
SMS
Website
Newspaper
Row 1
What area would you like to participate in our Program *
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