Membership

Membership Application

Kindly complete the for below to become a member.

Title:

Name *

First

Last

Current Position: *

Organisation/Affiliation: *

Organisation Address: *

Email *

Gender *

Male
Female

Date of Birth

Nationality *

FILL WHERE APPLICABLE

PERSONAL DETAILS

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone

Mobile

ACADEMIC QUALIFICATIONS WITH DATE

Institution Attended With Date

Membership of Other Bodies

Address you would like PBDC publications and correspondence sent *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

I hereby apply to become a member of the Peace Building Development Consult Forum.

My professional and academic qualifications are:

Special Knowledge and how acquired:

me, Forum? Address:

Signature *

Clear Signature

Date / Time

Sponsor’s Endorsement

I propose the above-named, who is personally known to me, as a Candidate for membership of the Forum

Name of Sponsor

Position of Sponsor

Official Address of Sponsor

Signature of Sponsor

Clear Signature

Annual membership subscriptions

Asso Membership
Full Membership
Corporate Membership
Fellow

Membership Fees

Category	Enrolment fee	Annual Subscription	Total
Associate Membership Full Membership, Corporate Membership, Fellow Membership	N30,000.00 N100,000.00 N1,000,000.00 (7-10) N5,000,000.00	N10,000.00 N25,000.00 N250,000.00 ----------------	N40,000.00 N125,000.00 N1,250,000.00 N5,000,000.00

This application form duly filled shall be accompanied by an enrolment fee appropriate to the grade of membership for which the candidate is applying. applicant is advised to read the brochure on membership before completing this form.