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Siglo XXI Young

Programme National Youth Movement ; ; ; ;

By advocacy of our rights!

Membership Form

National Youth Movement Programme

Names and Surname :__________________________________________________________

Age: _______________________ Date of Birth :_____________________________

:_________________________ City :_____________________________ Department

Home Address :___________________________________________________________

Email :____________________________________________________________

Social Networks: _______________________________________________________________

Cedula No.: Academic ____________________________Institución :__________________

Cell No. : ________________________ No. Conventional: __________________________

0500 Code

Select 3 themes in you would like to participate:

Environment:

Education:

Political Rights:

Genre:

Culture and Sport:

Organization:

mentions "3 skills that you think you like Young?

1 -

2 -

3 -

Animal Favoured: ; ; ; Favorite Color:

Member Firm: ________________________ Signature :_____________________ Responsible

believe in the power of generational for transformations in Nicaragua!