Volunteer Registration
Email
*
:
Password
*
:
Confirm Password
*
:
First Name
*
:
Surname/Last Name
*
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Sex
*
:
-- Select --
Male
Female
Date of Birth
Mobile Number
*
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Medical History:
*
Do you have a disability?
*
:
-- Select --
Yes
No
Please specify your disability
*
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Do you have a criminal record or are you wanted?
*
:
-- Select --
Yes
No
Please specify details
*
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Duties willing to perform*:
Telephone:
Occupation:
Address:
Area willing to support
*
:
RSA
Zambia
USA
Other
Please specify other area
*
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Duration willing to commit
*
:
2 weeks
1 month
3 months
6 months
1 year
I want to receive emails from our newsletter
I want to receive updates during disasters
I don't want to receive any information
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