Membership Application Online Form SECTION 1: GENERAL INFORMATIONFirst Name *Other NameSurname *Date *Nationality *State of origin *Company Name & Address *Address for Correspondence *Permanent Home Address *Phone *FaxEmail Address *Job Title *Nature of Work/Business *SECTION 2: ACADEMIC & PROFESSIONALProfessional Qualification starting with the most recent profession (e.g.) Law, Engineering, Medicine, Banking, Insurance, teaching, Architecture, consulting, professional qualification (eg): NIM, ANAN, ICAN, ACIB, CIS,Qualification obtained (1)Discipline (1)Date (1)Name of Institution (1)Qualification obtained (2)Discipline (2)Date (2)Name of Institution (2)Qualification obtained (3)Discipline (3)Date (3)Name of Institution (3)Qualification obtained (4)Discipline (4)Date (4)Name of Institution (4)SECTION 3: CATEGORY OF MEMBERSHIP YOU ARE APPLYING FOR.Tick as appropriate *Corporate MemberFull MemberFellowAssociate memberLicentiate MemberResearch FellowStudent memberAmount and Details of Bank draft enclosedSECTION 4: EMPLOYMENT HISTORYPosition held (1)Main responsibilities (1)Date [from - to] (1)Name of company (1)Position held (2)Main responsibilities (2)Date [from - to] (2)Name of company (2)Position held (3)Main responsibilities (3)Date [from - to] (3)Name of company (3)Position held (4)Main responsibilities (4)Date: from - to (4)Name of company (4)SECTION 5: REFERENCESREFEREE (1)-----------------------------NameJob TitleName of Organization and AddressTelephoneE-mail AddressCommentsREFEREE (2)-----------------------------NameJob TitleName of Organization & AddressTelephoneE-mail AddressCommentsREFEREE (3)-----------------------------NameJob TitleName of Organization & AddressTelephoneE-mail AddressCommentsI declare that the information given herein is correct to the best of my knowledge and I also agree to be bound by the rules and regulation of the institute of corporate governance, Nigerian as they now exist, and as they may hereafter be amended.Upload evidence of payment *Choose FileNo file chosenDelete uploaded fileMax file size: 1MBRegister Now >>Please do not fill in this field. Please do not fill in this field.
