Member Data Form

Surname

First Name

Middle Name

Sex

Phone/WhatApp Number

Email Address

Date of Birth

MM

DD

YYYY

Home Address

Village/Town/City of Residence

State of Residence

Marital Status

Number of Children

Have you farmed before

If yes, what crops

Highest Education Level

Are you part of a cooperative

If yes, name the cooperative

Do you have a bank account?