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ASSOCIATION OF NIGERIANS ABROAD |
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APPLICATION
FOR MEMBERSHIP |
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* Please send COMPLETED
form electronically to: Mr. Victor Adewusi E-mail address: vadewusi@yahoo.com |
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A. PERSONAL DATA 1. (a) First
Name.
....................................... (b) Last Name. ..................................... (c) Gender: Male
[ ] Female [
] 2. E-Mail address ....................................... 3. Telephone Number (Include Country
Code) ........................... 4. Fax
Number(Include country Code)
............................... 5. Postal Address ............................ .................................................... 6. Country of Residence .............................. 7. Profession/Occupation ............................. 8. If student, field of study ........................ 9. (a) Are you a Nigerian CITIZEN?
...................... (b) Country of
Citizenship............................ (If different from 9(a)) (Note: Non-Nigerian citizen if qualify,
will be considered for Associate Membership) 10. Are you 18
years old or above? (Yes/No)
.................... (Membership is granted to only those
who are at least 18 years old.) |
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B. ANA ATTRIBUTES 11. How did
you come to know about the ANA? ------------------------------ -------------------------------------------------------------------------- 12. The ANA Charter, states in part: "The
Association shall be non-profit, non-ethnic, non-religious, and non-partisan
in all its dealings with the people and Government of the Federal
Republic of Nigeria and the outside world. However, the Association
shall, as and when necessary, advocate for democratic ideals, human
rights, the rule of law, fairness, justice, and equity in Nigeria and
for all Nigerians. The composition of the Association shall reflect
the rich ethnic and cultural diversity of Nigeria." Is the
position expressed above consistent with your position? [
] YES [ ] NO If it NO,
please explain: ----------------------------------- 13. Name of
current employer -------------------------------------- 14. Are you a
member of any organization (excluding professional bodies) whose activities and interests
encompass Nigeria? [
] YES [ ] NO If yes, please state the following: (I) Name of organization:
......................... 15. Please
briefly state your interest in ANA and Nigeria : ..............
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C.
ANA PROGRAMS The ANA is a
goal-oriented association. Each member is expected to contribute
actively to the realization of ANA objectives. This is done by active
involvement in Committees that suit your skills and meet your
interests. 16. If your
membership application is approved, which ANA Committees do you intend
to join? Please check as appropriate.[We recommend no more than
two.]: [ ] Education Committee [ ] Welfare Committee [ ] Technology Committee [ ] Public Relations Committee [ ] Finance Committee [ ] Rules Committee [ ] Election Committee [ ] Fundraising Committee [ ] Political Affairs Committee [ ] Health Issues Committee I hereby
declare that the information I have provided in this e-form is true to the
best of my knowledge, and if accepted as a member/associate member, I will
abide by all the rules and regulations of ANA. Signed
............................. Date ............................... |
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DO NOT
WRITE BELOW THE LINE BELOW ____________________________________________ FOR ANA USE ONLY: (please DO NOT fill
this section) MEMBERSHIP Granted:........ Membership Number:......... ASSOCIATE Granted: ........ Date:................ AFFILIATIONS ------------------------ Inquiry Recvd: Appl. Recvd: Approved/Disapproved
(MC): Approved/Disapproved
(EXECO): _______________________________________________________________________ |