MEMBER APPLICATION

Mr./ Mrs / Miss :	Mr. Mrs. Miss
First Name :
Last Name :
Home Address:
Home Tel :
Business Address :
Occupation :
Work Tel :
E-mail :
Date of Birth : (day/mon/year)	/ /
SUPPORT :	Constituency in which you are Registered : (If Known)
	Please indicate the activities (if any) in which you wish to assist.
	Recruitment of Members
	Forming Constituency Branches
	Vote Registration
	House To House Campaign
	Polling Station Duties
	Political Education
	P.R Committee
	Fund Raising
	Other (Specify)
	I hereby apply for membership of the Bahamas Democratic Movement
	Date Of Application: (day/mon/year) / /