Full name
Full name must have 3 parts, each starting with a capital letter and between 3-20 characters.
Phone number (starting with 0xxxx...)
Phone number must start with 0 and be exactly 10 digits.
Sex
Select Gender
Male
Female
Please select a gender.
Email
Please enter a valid email address.
Region
Select Region
Arusha
Dar-es-salaam
Iringa
Kagera
Mbeya
Njombe
Pwani
Rukwa
Shinyanga
Tanga
Zanzibar-West
Please select a region.
District
Select District
Please select a district.
Password
👁️
At least 8 characters
At least one uppercase letter
At least one lowercase letter
At least one number
At least one special character
Password must meet all criteria.
Confirm password
Passwords do not match.
SUBMIT