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Personal Information

Full Name *

Full Name must contain only letters and spaces

Email *

Please enter a valid email

Password *

Password must be at least 6 characters

Member Type *

Please select a member type

Phone Number *

Please enter a valid phone number

Date of Birth *

You must be 18 years or older

Gender *

Please select a gender

Identification

National Identification Number (NIN) *

NIN must be 14 alphanumeric characters

Profile Picture (JPG/PNG, max 5MB) *

Profile picture must be JPG or PNG

ID Front (JPG/PNG, max 5MB) *

ID front must be JPG or PNG

ID Back (JPG/PNG, max 5MB) *

ID back must be JPG or PNG

Address and Workplace

Residential Address *

This field is required

Workplace/Occupation *

This field is required

Next of Kin

Next of Kin Name *

This field is required

Relationship *

This field is required

Next of Kin Phone *

Please enter a valid phone number

Emergency Contact

Emergency Contact Name *

This field is required

Emergency Contact Phone *

Please enter a valid phone number

Agreement

I agree to the Rules and Regulations *

You must accept the rules

I confirm all information is true and valid *

You must confirm information validity

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