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Membership Application Form

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PICK / DOWNLOAD YOUR MEMBERSHIP FORMS OF OUR TWO INTERNATIONAL ON** CALL*TO ANY CATEGORY OF HEALTHCARE WORKERS IN ANY OF TWELVE STATES OF NIGERIA(BELOW LISTED) *TO PARTICIPATE IN A NATIONAL SURVEY ON COVID-19
WHICH HAS BEEN ETHICALLY APPROVED IN MAY 2020 BY HOSPITAL MANAGEMENT BOARD ASABA, DELTA STATE, NIGERIA.

### NOW ONGOING IN 12 SELECTED STATES IN NIGERIA


 TERMS AND CONDITIONS FOR YOUR PARTICIPATION :

You subscribe to any category (ies) of membership (General--Form fee N1,000 per NGO/Foundations; Executive management--Form fee N2,000 per NGO/Foundations; international advisory board--form fee N1,000 per NGO/Foundation; trustees--Form N100,000 per NGO/Foundations)

NB: All payments to our NGO bank account(s);
Payment to individuals is at your own risk...

NB2: Pay in Naira if residential in Nigeria (UBA PLC Account details available on request)

NB3: Pay in US$ if outside Nigeria (Ecobank PLC available on request)


Carefully fill the online form below and our team member will get back to you or you can alternatively download a copy of the form and submit to our office.
Download Form


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DO YOU BELONG TO A COOPERATIVE SOCIETY?pick one!
Have You Benfited From Any Organization?pick one!
Are You Interested in Any Form Of Sponsorship?pick one!
Have You Been Convicted Before?pick one!
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