Formulaire d’inscription

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Vous souhaitez vous engager aux côtés du Camp National et participer à la construction d’une nouvelle dynamique politique pour Haïti ?

Remplissez ce formulaire afin de manifester votre volonté d’adhérer au Camp National (CANAL). Les informations fournies permettront à notre équipe de vous contacter, de vous informer sur les activités du parti et de vous orienter vers les structures appropriées.

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Member's name *

Prénom

Nom

Member's date of birth *

State of residence

City of residence *

WhatsApp number *

+1 (754) XXX-XXXX

E-mail

How would you like to be contacted ?

Whatsapp
Phone call
E-mail
SMS

Why do you wish to join the National Camp?

This question allows us to distinguish between someone who simply wishes to receive information and a person who genuinely wants to get involved.

How → what

How would you like to contribute to the party's activities ?

Participation in activities and meetings
Community mobilization
Communication and social media
Event Planning
Analysis and proposals regarding public policies
I simply wish to be informed for the time being.
Others

Have you ever participated in a National Camp activity?

If yes → Which one?

What is your main business activity ?

In what field do you have skills or experience ?

Communication, IT, Agriculture, Education, Law, Finance, Organization, Entrepreneurship, Media, etc.

Confirmation of your request

I confirm that the information provided in this form is accurate and that I wish to be contacted by the National Headquarters regarding my membership application and party activities.

Consent to receive communications

I agree to receive information, invitations, and communications from the National Camp via the contact details provided.

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jdafils@yahoo.com