Full Name

First

Middle

Last

NIN Number

Number City leadership

Date of Birth

Phone Number

Email Address

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 SHERISE: Women Empowerment Through Community and Growth

We believe that empowering women creates stronger families, resilient communities, and sustainable development. By partnering with stakeholders, community leaders, and development organizations, Sherise Women Empowerment works to promote gender equality, reduce poverty, and inspire lasting positive change.

SheRise

Join SHERISE: Women Empowerment Through Community and Growth