Membership Form – SheRise

Full Name

First

Middle

Last

NIN Number

Date of Birth

Phone Number

Email Address

Contact roles? Emergency

Home Address

City / State / Country

Field of Work

Are you willing to actively participate in group activities and programs?

Are you interested in volunteering or taking leadership roles?

Yes
No
Maybe

Emergency Contact Name

First

Last

Emergency Contact Relationship

Emergency Contact Phone Number.

Beneficiary (1)

Please fill in the FULL Names, NIN number, ADDRESS and PHONE Number.

Beneficiary (2)

Please fill in the FULL Names, NIN number, ADDRESS and PHONE Number.

Beneficiary (3)

Please fill in the FULL Names, NIN number, ADDRESS and PHONE Number.

Beneficiary (4)

Please fill in the FULL Names, NIN number, ADDRESS and PHONE Number.

Declaration

I agree

I confirm that the information provided is true and correct. I agree to abide by the values, rules and objectives of the Women Empowerment Group.

Signature

Join SHE RISE: Empowerment Through Community and Growth

This section provides a detailed and comprehensive overview of your company’s mission, values, and history. It highlights the key principles and values that drive the purpose, goals, and long-term success of your brand and business operations.