Food Sovereignty Ghana

A grass-roots food advocacy movement of Ghanaians both home and abroad!

Application for Associate Membership

copy-FSG-LOGO.jpg

 

 

FOOD SOVEREIGNTY GHANA

 

 

 

APPLICATION FOR ASSOCIATE MEMBERSHIP REGISTRATION FORM

 

Please complete this form with the necessary accurate information. Registration fee is GH5.00.

1.(a) Surname:…………………………………………………………………….

 

(b) First Name:…………………………………………………………………….

 

(b) Other Names:…………………………………………………………………

(b) Date and Place of Birth:  ………./………../…………….  Place of Birth

(d) Residential Address:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

 

  1. (a) Email Address: ………………………………@………………………………

(b) Mobile Phone No. s: ………………………………………

4. (a) Profession:

(b) District:

5.Current/Last Educational Institution Attended:

  1. Institution: ………………………………………………………………………………………………………………

  2. Address: ………………………………………………………………………………………………………………

  3. Period From: ……………/…………… To ………/…………./……

6. Tick any of the following and attach to this form;

ID card: Drivers License NHIS Passport National Identification

Date of Issue: ……..…/….……/…………

Expiry Date: ………. /……………/……………

Day Month Year

7.Signature/Thumb Print:

………………………………………..

Membership Code: FSG/…../…../…………….

[photo]

 

 

I, (NAME) …………………………………………………………………………………………….. Certify that the above information is accurate and also declare to abide by the rules and regulations of FOOD SOVEREIGNTY GHANA.

 

Signature:………………………………………………………………….. Date: ………/……../……………

 

 

 

 

 

Comments are closed.