People’s Alliance for Good Governance

Enrollment Form

Name

Male/Female

Age

Parents’ Name

Full Address

Telephone, e-mail

Education

Profession

Service organization if any

Other interests

Introduced by

Name

Address

Declaration

I hereby agree to abide by the rules and regulations of People’s Alliance for Good Governance and am willing to join the fight against Corruption, Hunger, Ignorance and Disease.

Date Signature