Registration Page - The Convergence

Northern Region Registration Form

Please apply by filling out the details below.
Given the volume of applications we are receiving, we are unable to contact applicants with information on the status of their application. Only selected applicants who meet the criteria will be contacted.

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About You

Name*

Prefix

First

Last

Date of Birth*

Gender*

Employment & Voter registration Status

Employment Status*

Are you a registered voter*

Geo-Political Zone*

State of Origin*

State of Residence*

Political party you are a member of?*

How long have you been a member?*

Are you a current Lawmaker from the Northern Region?*

Evidence of party membership*

Maximum size 2MB. JPG only please

Letters of recommendations*

Upload your letter of recommendations an official or top member of your political party

Maximum size 5MB. PDF only please

Do you hold a leadership position in the party?*

Elective office of interest*

Which electoral cycle are you contesting in?*

Have you run for office before?*

If yes, what year did you run for office?*

If yes, what office did you run for?*

Upload your Mean of Identification

Drivers license, Voters card, National ID, International Passport

Upload Your Valid ID*

Maximum size 5MB. PDF, JPG only please

Online CV / Portfolio link (If Available)

Provide the link here. EG: http://www.linkedin.com

Upload passport photograph*

Passport size must be: Height 45mm - width 35mm

Maximum size 2MB. JPG only please

Tell us why you are running for office?

(150 words max)

How do you intend to win the election for your desired elective office?

(150 words max)

What actions have you taken so far to actualize your intention to run for office?

(150 words max)

How would you like to be contacted?

Home / office

Mobile / cell phone

Mobile Tel

Home Tel

Email address*

This field should be left blank