The Base

    THE BASE MOVEMENT

    Youth Wing Enrolment Form

    Ages 14 to 17 · Civic Education · Mentorship · Community Service

    Membership number

    Issued by HQ as
    TBM-YW-######
    once entered

    Read before signing. Under the Constitution of Ghana, political party membership is tied to the voting age of 18. The Youth Wing is a civic and mobilization programme, not political party membership. It carries no voting rights, no leadership eligibility and no part in any internal decision of the Movement. We do not collect a Ghana Card number or a Voter ID number on this form. No officer can issue or promise a membership number. Your TBM-YW- number is generated by the system only when this form is entered into our database, and is then given to you.

    1About the young person

    Full Name (first and last) *

    Date of Birth (DD / MM / YYYY) *

    Age on today's date *

    14
    15
    16
    17

    18 or older? Use the adult membership form instead.

    Gender *

    Male
    Female

    Religion (optional)

    Christian
    Muslim
    Traditionalist
    Other
    2Where you live

    Region (tick one, if you live in Ghana) *

    Ahafo
    Ashanti
    Bono
    Bono East
    Central
    Eastern
    Greater Accra
    North East
    Northern
    Oti
    Savannah
    Upper East
    Upper West
    Volta
    Western
    Western North

    If you live outside Ghana, country of residence (e.g. United Kingdom)

    Town / Community

    3School

    Education level *

    Junior High School
    Senior High School
    Technical / Vocational
    Out of school
    Other

    Name of school (optional)

    4Parent or guardian consent (required)

    Guardian Full Name *

    Relationship to the young person *

    Mother
    Father
    Legal guardian
    Grandparent
    Aunt / Uncle
    Other

    Guardian Phone Number * (we call this number to confirm consent before activation)

    I am the parent or legal guardian named above. I consent to this young person joining The Base Movement Youth Wing as a civic and mobilization member. I understand this is not political party membership and carries no voting or leadership rights in the Movement, and I agree to be contacted on the number above to confirm this consent.

    Guardian signature or thumbprint

    Date

    Enrolling officer name

    Officer signature

    Entered & consent confirmed by (HQ)

    Return completed forms to the nearest Base office. Your membership number is issued after entry, and can be checked at thebasemovement.org.gh/youth-wing/portal. Enrol online instead at thebasemovement.org.gh/youth-wing/register