Form Direct Membership – Institute of Health Science, Research, and Administration of Nigeria

APPLICATION FORM FOR DIRECT MEMBERSHIP INTO IHSRAN

Applicant Full Name Here *

Email Address *

Phone/WhatsApp Number *

City *

State/Province

Country

Date of Birth *

Day *

Month *

Year *

Gender *MaleFemale

Membership Levels of Admission *

Why are you interested in becoming a member of the institute ? *

How do you believe your skills and experience align with the institute's goals and objectives?

As a member of the institute, you may be assigned to participate, take portfolio and represent the institute in its routine activities, services and programs according to its object or those that maybe assigned by the board. Will you be willing to commit to the terms and responsibilities required by the institute for such responsibilities? *YesNo

UPLOAD THE FOLLOWING BEFORE SUBMITTING

1. Passport Photograph: [Upload – Recent only] *

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2. UPLOAD YOUR CV/RESUME: [PDF/WORD – Max 2MB] *

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3. Evidence of Application Form Payment: [Upload Payment Receipt] *

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