You are on page 1of 1

RESTORATION ACTORS

MEMBERSHIP FORM
The information requested in this form is used to manage all aspects of your membership with the group.
Note that all personal information you provide will be safe and secure and will only be used for lawful
purposes .you have the right to access and update the information you provide.

1. PERSONAL DETAILS

FIRSTNAME MIDDLENAME SURNAME

STAGENAMES

GENDER: MALE FEMALE


DATE OF BIRTH
PLACE OF BIRTH
TRIBE
NRC
MARITAL STATUS
SPOUSE

MEDICAL CONDITION
YEAR/DATE ARRIVED
2. CONTACT DETAILS

MOBILE # EMAIL
ADRESS

3. PARENTAGE / GUARDIAN

NAME SURNAME
GENDER: MALE FEMALE RELATIONSHIP
MOBILE NRC#
By affixing my signature below I confirm the info provided above is true and I accept the policies and
laws of the group and I will abide by them
SIGNATURE:…………………..

You might also like