THE BASE MOVEMENT
Ghana Membership Form
Ghana First · Youth Empowerment · Community Mobilization
AFFIX PASSPORT
PHOTO HERE
Full Name (As shown on your ID Card or Passport) *
Birth Year (e.g. 1992)
Gender *
Age Range *
Under 18? Use the Youth Wing form instead. Party membership is tied to the voting age of 18.
Ghana Card Number * (e.g. GHA-123456789-0)
Voter's ID Card Number * (10-digit Voter ID)
Religion
Primary Phone * (e.g. +233 24 123 4567)
Secondary Phone (optional)
Email Address (optional, but advised)
Digital Address (Ghana Post GPS) (e.g. GA-183-9020)
Region * (Tick the region where you vote)
Constituency * (e.g. Ayawaso West Wuogon)
District (e.g. Ayawaso West Municipal)
Polling Station Code / Name (e.g. C090201, Bawaleshie Primary School)
Employed *
Job Level (if employed)
Profession / Job Title (tick one or write below)
Other Profession / Job Title (write here if not listed above)
Education Level
Emergency Contact Name
Emergency Contact Phone
Relationship Options:
FOR OFFICIAL REGISTRAR USE ONLY
Permanent Reg No Allocated (e.g. TBM-GH-268108 (Required if registering on behalf of applicant, e.g. Referee))