KAGA COMMUNITY DEVELOPMENT ASSOCIATION
MEMBERSHIP APPLICATION FORM
Passport photo
1. Personal Information
First name:
Middle name:
Surname:
Gender:
Date of birth:
Marital status:
Phone number:
Contact-person phone:
Email address:
2. Residence and Identification
Country of residence:
State / Province:
LGA / City of residence:
Kaga ward:
Community or village:
Means of ID:
ID number:
Residential address:
3. Education, Occupation and Membership
Educational level: No formal education / Qur’anic or Islamiyya / Primary / Junior Secondary / Senior Secondary / Vocational or Technical Certificate / NCE / ND / HND / Bachelor’s Degree / PGD / Master’s Degree / PhD:
Occupation (optional):
Employment status (optional):
Business or skill (optional):
Specify other skill (optional):
Membership category:
Special assistance required:
4. Next of Kin
Full name:
Phone number:
Relationship:
Address:
5. Declaration and Consent
I declare that the information provided is true and complete. I authorise KagaCDA to securely use it for membership administration and official communication.
Applicant signature or thumbprint / Date
Registration Officer / Date
Registration fees: ₦2,000 Registration and I.D. Card + ₦1,000 Annual Membership Subscription (current year).
Payment: Kaga Community Development Association · Jaiz Bank · 0002827339.
Return this completed form and proof of payment to an authorised Registration Officer. A portal account is activated only after payment verification and membership approval.
Payment: Kaga Community Development Association · Jaiz Bank · 0002827339.
Return this completed form and proof of payment to an authorised Registration Officer. A portal account is activated only after payment verification and membership approval.