MEMBERSHIP APPLICATION FORM                                  

 

Title:  Surname: First name/middle names (in full):
Contact Address:

Gender: (Male/Female)          

  Date of Birth:
Nationality:
State of Origin:
Mobile:
Home Tel:
Office Tel:
Fax:
 
L.G.A:
Alt. E-mail (if any)
Residency & Location of the Applicant
City
How did you get to know of A.N.R.A.G
E-mail:

Employer's Name/ Institute Name (if self Employed, please state the type of work or business)

Next of Kin (One from country of Residence and the other from Nigeria)

Name:  

Address:

Tel:       

Mobile: 

Fax:      

Email:    

 

 

 

 Name:  

Address:

Tel:       

Mobile: 

Fax:      

Email:   

 

 

 Profession or Position in Company: (E.g. Medical Doctor, Athlete, Engineer, Teacher, Lab. Technician, Footballer, etc. If Student, Please specify course of study. If self-employed, what is the nature of your business?)
Do you belong to any other Association, Political Party or Organization, Yes No If yes, please list them with your position

Interests/ Hobbies/ Other Information to let us know more about you: If you are finally admitted as member, are you ready to serve in any of our committees? Yes No

I   here freely and genuinely decided to be a member of ANRAG. I undertake to abide by the rules and regulation of the ASSOCIATION. I further undertake to conform to and promote the policies, goals and objectives of the ASSOCIATION. I also confirm that all the information supplied in this form is true and correct.

Date:          Attach your photograph:
                                                 SUBSCRIPTION INFORMATION
Subscription Details Due Full Time Student / Person above 70
Membership Fee $90.00 $20.00
Yearly $90.00 $20.00
Total: $180.00 $40.00
(This fee can be in dollars or its equivalent)
Voluntary Contribution (Optional)
 

 

Please forward your crossed cheque/money order marked "Account payable Only" (payable to ASSOCIATION OF NIGERIAN RESIDENTS IN ARABIAN GULF)

Attention : General Secretary

ASSOCIATION OF NIGERIAN RESIDENTS IN ARABIAN GULF

KUWAIT
 

The information contained in this Form is subject to terms of the Data protection act 2002