Fields marked with a " * " are required. Are you a registered voter? YesNo Personal Details Title ---Mr.Mrs.Ms.Dr.Esq.Hon.Sr.Jr.Prof.Rev. ID Number First Name(s) Surname Address House/Flat Number Street/Road Name Suburb City/Town Ward Number Municipality Contact Details Tel (W) Tel (H) Cell Email Fax Previous Party Membership If you were a member of another party, list full details below. Name of Party Date of Resignation Declaration I, the undersigned, hereby declare: That I agree to be bound by the Constitution, Code of Conduct and Rules of the Minority Front. Declare that I am not a member of any other political party or political organisation. Please attach a copy of your ID along with the application.