helprapevictim.org

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User Agreement

I agree and embrace it  (PLEASE CLICK HERE TO READ IT)

I hereby apply for membership in Socoodeife for

Full Membership
Associate Membership

What is your name?

What is your gender?

Male
Female

What is your date of birth? (Day/Month/Year)

What is your nationality?

What is your mother tongue?

What other languages do you speak, apart from your mother tongue?

What is your current occupation?

In which country are you presently residing?

Current Street Address Line 1

Address Line 2

City

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Email

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If you have a Blog Page or Website write URL address below

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Are you currently a member of any Non-Profit Organization?

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No

If yes, list the names of the organization/s you are a member of

Why do you want to become a member of Socoodeife?

Do you live a lifestyle free from alcohol and other drugs?

Yes
No

As a Socoodeife member, are you willing to make a Pledge to live free from alcohol and drugs?

Yes
No
Maybe

What abilities and skills do you have that might be of benefit to Socoodiefe? (For advocacy, prevention, rehabilitation and treatment, community, development, human rights promotion etc.)?

Please write any other relevant information you wish us to know about you

Please select below as many as you are interested in and we will make sure to involve you in all the action

Prevention of abuses against WOMEN

Assisting in projects to help WOMEN recover from the effects of abuse

Prevention of abuses against CHILDREN

Assisting in projects to help CHILDREN recover from the effects of abuse

Today’s date (Day/Month/Year)

User Agreement

By submitting this form, you confirm that you have read and understood the Socoodeife Mission, Vision, Core Values and Principles and you agree to uphold them to the best of your ability. (PLEASE CLICK HERE TO READ IT)