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Self-onboarding form for Farmers
Please fill the form below to receive personalized messages from us
Personal Details
First Name
Last Name
Phone Number
Email Address
(Optional)
Gender
Male
Female
Male
Marital Status
Single
Maried
Single
Date of Birth
Educational Level
Primary
Secondary
Tertiary
Religious
Primary
Your Location
State
Adamawa
Gombe
Bornu
Adamawa
Local Government
Town / Village
Other Information
Crops Cultivated
Rice
Tomatoes
Groundnut
Sorghum
None
Nothing selected
Animal Reared
Sheep
Goat
Poultry
Cattle
Pig
None
Nothing selected
Farm Size
1 hectar
1 - 2 (hectars)
2 hectars
2 - 3 hectars
3 hectars
3 - 4 hectars
4 - 5 hectars
5 hectars
1 hectar
House Income
less than 10,000
10,000 - 20,000
20,000 - 30,000
30,000 - 40,000
40,000 - 50,000
greater than 50,000
less than 10,000
Any Disability?
Yes
No
Yes
How did you hear about us?
Farmer's Groups
Radio
Govt/Agencies
Field Agent
Mobile Phone
None
Nothing selected