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.Register Now >>Please do not fill in this field. Please do not fill in this field.
