Registration Form
295, Ikorodu road, Idiroko Bus-Stop, Maryland, Lagos
Email: nursesacrosstheborders@nursesacrosstheborders.4t.com
Registeration Form

Partners/Associates

Organograph

More About Us

NAB Update

-NAB-


Membership/Registration

Nurses Across The Boarders has fulfilled the conditions spelt out in section 40 & 41 of the 1999 constitution of the Federal and other laws regulating NGO functions in Nigeria.

Just go down, highlight and print the forms one and two from seperate A4 sheets, fill and send to us via the above address, OR attach and mail to our email address.

Highlight from (Membership Form) below.

BUILDING PARTNERSHIP FOR COMMUNITY HEALTH_______________________________________________________ print each page differently by highlight/selecting each page before printing (highlight and stop at the end of each page thent print; do so to forms/pages 1, 2, 3)... Highlight from (Membership Form) below.

___________

MEMBERSHIP FORM

______

Instruction:

Please print and fill this form by hand in capital letter and submit with 2 recent passport  photographs and a Membership fee of .00c (Ten Dollars) to the above address.

  Personal Data

 1.  Name: ................................................................................................................................

2.   Sex: ....................................................................................................................................

3.   Date of Birth: ....................................................................................................................

4.   Marital Status: ..................................................................................................................

5.   State of Origin: .................................................................................................................

6.   Nationality: .......................................................................................................................

7.   Telephone: .......................................................................................................................

8.   Residential Address: .....................................................................................................

9.   Office Address: ...............................................................................................................

10. Postal Address: .............................................................................................................

11. Occupation/Profession (area of socialisation):........................................................

12. Intending area of Operation (Where You wish to operate) As a Member: .........

.................................................................................................................................................

13. Do you belong to any like organisation? .................................................................

14. Name of Organisation (If yes): ..................................................................................

15. Why do you wish to join Nurse across the borders? ...........................................

................................................................................................................................................

................................................................................................................................................

16. Do you own an international passport? ....... Number .........................................   

       Issuing Authority ...................................

 

page 1________________________________________________ page one


ADDITIONAL INFORMATION TO BE SUPPLIED BY

STUDENTS WISHING TO BE MEMBERS

 Name of Institution: ...............................................................................

............................................................................... ...............................

College/School/Faculty/Department: ................................................... 

Matriculation Number/Index Number: ....................................................

Admission Number: ............................................................................... 

Address (on or Off Campus): ................................................................

................................................................................................................  

Position in Student Union Government (If a member): ..........................

Position in any other Organisation on Campus: .....................................

 

WORKERS' BOX

1.       Place of Work ..........................................................................................................

2.       Address: ..................................................................................................................

3.       Position at Work: ...................................................................................................

4.       Office Telephone/Telex/Fax Numbers: .............................................................

5.       Do you belong to any Trade Union/Professional Body? ...............................

6.       If yes, Specify .........................................................................................................

 

end of page 2------------------------------------------------------------------- end of form two

_________________________________________________________________

UNDERTAKING

 I ............................................................ a citizen of .............................................. wish to be bound by the constitution of Nurses Across the Boarders and other validity made rules and regulations and I undertake to carryout with utmost dedication and steadfastness all duties assigned to me and meet all obligations arising from my membership.

  

 DECLARATION

 I .................................................................... a citizen of .......................................... solemnly declare that all the information stated above are true.

                                                                                 Name: .................................................

                                                                                 Signature: ...........................................

                                                                                 Date: ....................................................

 

 

For Office Use Only

  

        1.       Membership Form Fee Paid/Unpaid*

Name of Receiver: ....................................................................

Signature of Receiver: .............................................................

 

2.       State Recommendation:

I .............................................. State Chairman, recommend/does not recommend the application for membership OF NURSES ACROSS THE BOARDERS.

                                                                Signature: .................................................

                                                                Date: ..........................................................

 

 

        3.       International Approval:

I ................................................................., the international Chairman/Executive Director hereby  recommend the application for membership OF NURSES ACROSS THE BOARDERS.

                                                                 Signature: .................................................

                                                                 Date: ..........................................................

 

                                        Membership Number: ................................

 

page 3 ---------------------------------------------------------------------------- end of form 3





Nostrodamus - 234-80-43269736