Extract and list all the information provided in the membership form.

Here is the information extracted from the membership form:

• Name: Rita Sallen Lepolu
• Date of Birth: June 18, 1989
• Current Address: Compound #2, Larkay-Ta Township
• County of Origin: Margibi (District: Town, Town/City: Town)
• Nationality: Liberian
• Occupation: Self Employed Business
• Previous Organization: Trust Larkay-Ta Women group
• Marital Status: Divorced
• Father's Name: Amos Lepolu
• Father's Address: Compound #2, Larkay-Ta Township
• Mother's Name: Mary Lepolu
• Mother's Address: Compound #2, Larkay-Ta Township
• Reason for joining: "I want to be part of organization because it bring unity among women."
• Emergency Contact Name: Andrew A.S. Lepolu
• Emergency Contact Address: Compound, Larkay-Ta
• Emergency Contact Cell#: 0776-832-090
• Pledge Signed By: Rita S. Lepolu
• Pledge Date: May 11, 2026