Diaspora Membership

Diaspora Membership Form

SURNAME

Jamaican Passport No.

First Name

Middle Name

____________________________________________________________________

Zone: (Official use only)

Division: (Offial use only)

____________________________________________________________________

Address:

Date of Birth:

Gender:

MaleFemaleOther

Country:

Telephone Contacts: Home:

Mobile:

WhatsApp:

YesNo

Email:

Occupation:

_____________________________________________________________________

Employment Status & Academic Levels

Please check appropriate boxes:

EmployedSelf-EmployedUnemployedRetiredStudentSecondaryTertiaryUniversityPost Graduate

____________________________________________________________________

References from two Party Members

NEC/Region Chair/Commission Chair/Zone Chair/ Member of Parliament/Councillor

(Each person must sign this form which indicates agreement to be used as reference)

____________________________________________________________________

Reference 1:

Name

Position

Phone Number

____________________________________________________________________

Reference 2:

Name

Position

Phone Number

____________________________________________________________________

Applicant: Please indicate if you had/have

Previous MembershipCurrent MembershipNot Applicable

If yes, please list constituency:

Please indicate a maximum of two - one Commission & one special interest; or two special interests:

Party Commissions

Outreach and RecruitmentPolitical Education and TrainingCommunicationsInternational and Diaspora AffairsWelfareFinance and Fund RaisingHuman RightsGenderHeritage Committee

Special Interests

Trainers: Jamaica (Terry level education desirable). Election worker, & election preparednessSuper Canvassers: Jamaica (Field work activity primarily on weekends - must be skilled in person-to-person contact)Technology Liaisons: to work with divisions and constituencies and campaign teams in Jamaica; and to work within the Diaspora RegionCommunication Liaisons - Jamaica and DiasporaElection Campaigning Field Work - JamaicaAdministrative - Jamaica and DiasporaPolitical Education - DiasporaMembership & Recruitment - DiasporaAny Other Areas (Please Indicate)

*List Other Areas Here (If applicable)

____________________________________________________________________

Applicant's Name

Date

Choose (1) one of the following options: Type or Draw Signature.

Type Signature Here

Draw Signature

(Sign Here)

Clear Signature

____________________________________________________________________

Please attach Proof of Jamaican Citizenship (JA Passport); and overseas residency

Upload 3 Items Max

Item 1upload

Upload

Item 2upload

Upload

Item 3upload

Upload

Declaration (Tick the checkbox to confirm)

Declaration

I confirm all information submitted is true and that I am the person stated herein.

____________________________________________________________________

(For Official Use Only)

Rejected: _____________________

Denied: _____________________

Approved: _____________________

Date: _______________________

Contacts

RESOURCES

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