Member Registration - CHONGAHBDAH

Personal Information - All fields required

First Name

Last Name

Email

Phone

Password Minimum 6 characters

Confirm Password

Gender

Date of Birth

Marital Status

Number of Children

Contact Details - Residential Address required

Residential Address

Permanent Address

Additional Phone Numbers

Alternative Email

Membership & Employment Details - Category required

Category of Membership

Occupation / Institution / Employer

Place of Work

Year of Employment

Grade Level

Expected Year of Retirement

Educational Information (Students Only) - Required for students

Institution Name

Course of Study

Education Level

Expected Year of Graduation

Institution Address

Self-Employment Information - Optional

Nature of Business

Business Address

Business Registered?

Can Train Apprentices?

Identification & State of Origin - State & LGA required

NIN Number

VIN Number (Driver's License)

State of Origin

LGA

Indigene Certificate?

Registration Details - All fields required

Registration Type

Chapter/Branch

Payment Method

Next of Kin Information - Name, Relationship & Phone required

Full Name

Relationship

Phone Number

Address

Declaration - Must be confirmed

I hereby declare that:

All information provided is true and correct
I will abide by the constitution and rules of Chongahbdah Association
I will pay my dues and obligations as and when due
I am committed to the progress and development of the association

I confirm the above declaration *

Full Name (for declaration)

Date