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Membership Application Form

This form must be accompanied by an application fee of #5000 payable
to IBCHCP Account Number 1015603905 UBA PLC.

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Please provide your full address
Academic & Professional Qualifications
Enter the Names of institutions attended with Degree awarded and Year. Starting withe the highest qualification
Enter the names of awarding institutions and year obtained
List the THREE(3) positions you have in your employment history, beginning with the current. State the Name of Organisation, Position held and Date
SponsorPlease give the name and full address of ONE sponsor. Your sponsor must be a professional member of the institute or your Department Head, who hknowaledge professional responsibilities and should not be related to you. Your sponsor is your Referee.
Please give details
I declare that the information given herein is correct to the best of my knowledge, I agree to be bound by the Rules and Regulations of IBCHCP as they now exist, and as they may hereafter as ammended.

Fields with (*) are compulsory.