Register ‐ Pays4Life : Live your Dreams

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Registration Process

Personal Information

First Name

Please type your First Name

Name Looks good!

Name must be above 2 letters & must not contain digits.

Last Name

Name Looks good!

Please type your Last Name

Name must be above 2 letters & must not contain digits.

Email Address

Please enter a valid Email Address

Email Looks good!

Must be a valid Email Address

Confirm Email Address

Please type the same Email Adress

Must be the same Email Address

Phone Number

Please enter a valid Phone Number

Phone Number Looks good!

Must be a valid Phone Number

Confirm Phone Number

Please type the same Phone Number

Must be the same Phone Number

State Residence

Please Input your State of Residence

State looks good!

We require your state of residence

Country Residence

Please choose your Country of Residence

Country Selected

We require your country of residence

Next of Kin's Details

Next of Kin's Full Name

Please type next of Kin's Full Name

Name Looks good!

Name must be above 2 letters each & must not contain digits.

Relationship

Please select Relationship

Relationship Selected

Please select relationship b/w you and your next of kin.

Next of Kin's Phone Number

Please enter a valid Phone Number

Phone Number Looks good!

Must be a valid Phone Number

Sponsor/Referrer Details

Referred By

check spelling

Username of your referrer/sponsor, leave blank if no one referred you.

By Clicking Continue, You Agree to terms and conditions

Username

Please choose a Username. Username must not include a space or contain special character

Username Looks good!

Username must be above 2 characters & must not contain special characters; must not have a space.

Password

Please set your password

Password Looks good!

Must be 4 characters and above.

Confirm Password

Enter the same Password.

Password Looks good!

Password must be the same.

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