Registration Form

First Name(*)
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Last Name(*)
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Username(*)
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Email(*)
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Please make sure the email address is yours. The system will send an email to this address in order to validate you.

Password(*)
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Verify Password(*)
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Address(*)
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Date of Birth
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Affidavit ID
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Village(*)
What is your village?

Election District(*)
Please select your Election District

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