Alexandra Community Dialogue

This is A Voluntary Register of Alexandra Community, led by the Ministers and Pastors keen on facilitating a better and improved Township.

REGISTRATION FORM

Alex Community Dialogue Voluntary Register. Empowering Alexandra Township Together.

First Name *

Surname *

Cell Number *

Email Address(optional)

Current employment status (optional)

What is your age group? (optional)

Would you like to be notified of Employment Opportunities?

Would you like to be notified of Business Opportunities?

Select the primary area of concern you are reporting today:

Severity in daily life? (1 = Minor, 5 = Critical Crisis)

How frequently does this impact you?

What primary intervention would address this best?

Briefly describe the exact location or detail of the problem: