Personal Information
Spouse and Next of Kin
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Title (required) MrMrsMissDrProfEngArch.AlhajiAlhaja
First Name (required)
Surname (required)
Maiden Name
Date of birth (Day and Month) (required)
UK Address (required)
Religion (required)
Telephone Number (required)
Email Address (required)
Choice of meeting minutes preference Soft CopyHard Copy
Family Address in Ikorodu (required)
Other Addresses in Nigeria
Occupation
Membership of any Professional or Non-Professional Organization
Which of your parents is a native of ikorodu? (required) FatherMotherBoth
Spouse/Next of Kin
Spouse Information
Name (Optional)
Date of Birth (Optional)
Religion (Optional)
Address (Optional)
Telephone Number (Optional)
Email (Optional)
Next of Kin
Name (required)
Address (Required)
Email (required)
Children Details (Optional)
How did you hear about us (required) FriendsFamily FriendSocial EventsWebsiteOther
Declaration
I understand that some or all the information supplied may be retained for record purposes, my consent is hereby given in this regard.
I understand that my Membership shall be terminated for any proven act of Gross misconduct.
I understand that my Membership may be terminated if I fail to keep up with all my Financial obligations.
I confirmed that the information I have provided is true and correct, I understand that any false and/or misleading statement made by me on this Application form may be sufficient ground for the termination of my membership.
I consent to the terms and conditions (Click the check box to sign)
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