Register - Evergreen Co-op Society

Basic Information

First Name

First name is required. Example: John

Last Name

Last name is required. Example: Doe

Gender

Please select your gender

Phone Number

Valid phone number required. Example: +234 803 456 7890 or 08034567890

Email Address

Valid email required. Example: john.doe@example.com

Address

Full address is required. Example: 123 Main Street, Lagos, Nigeria

Branch

Please select your branch

Date of Birth

You must be at least 16 years old to register

First Name

Next of kin's first name is required

Last Name

Next of kin's last name is required

Relationship

Please select your relationship with next of kin

Phone Number

Valid phone number required. Example: +234 803 456 7890

Email Address

Valid email required. Example: jane.doe@example.com

Address

Next of kin's full address is required

Username

Username must be at least 3 characters. Example: johndoe123, alice_wonder, mike2024

Password Requirements

Password does not meet all requirements

Password must contain:

At least 8 characters

One uppercase letter (A-Z)

One lowercase letter (a-z)

One number (0-9)

One special character (!@#$%^&*)

Examples: MyP@ssw0rd, Secure#123, Hello$World9

Confirm Password

Passwords must match exactly

Account Type

Please select an account type