1 Step 1 2 Step 2 3 Step 3 Surname National ID -Voter ERN First Name Middle Name Constiuency Division Direct Member(Please tick)YesNoNot Sure References from two Party Members NEC / Constituency Committee, Member of Parliament / Councillor Name Position Name Position Address Date of Birth SexMaleFemale Telephone Contacts: Home/Work Phone No.1 Phone No.2(if applicable) Email Occupation Employment Status and Academic Levels - Please tick appropriate boxesEmployedSelf-EmployedUnemployedRetiredStudentSecondaryTertiaryUniversityPost Graduate Please indicate a maximum of two interests Party Commissions and CommitteesOutreach and RecruitmentPolitical EducationCommunicationsInternational AffairsWelfareFund RaisingHuman RightsGender and WomenICT CommitteeHeritage Affairs CommitteeCultural Affairs & Development CommitteeAwards and Recognition Committee Special Interests Party Commissions and CommitteesTrainers: Tertiary level education desirable, but not compulsorySuper Canvassers (Field work activity primarily on weekends)ICT Liaisons (to work with divisions and constituencies)Communication LiaisonsPolicy Committees - Economy and ProductionPolicy Committees - Human Resources and DevelopmentPolicy Committees - Infrastructure and Physical DevelopmentPolicy Committees - Governance and EthicsFamily and Parenting CommitteeThe Wellness and Health NetworkEnvironmental Protection LobbyEconomic Enablement Projects & Business Support ProgrammesField WorkAdministrative Name(your full name) Date Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder
