Name(Required) First Last Date of birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone number (mobile or landline)(Required)Hometown (place of birth) Place of stay (current location)(Required) Region (current region)(Required)Ahafo RegionAshanti RegionBono RegionBono East RegionCentral RegionEastern RegionGreater Accra RegionNorth East RegionNorthern RegionOti RegionSavannah RegionUpper East RegionUpper West RegionVolta RegionWestern North RegionWestern RegionAre you Ghanaian?(Required) Yes No Reason for SigningNameThis field is for validation purposes and should be left unchanged.
