Sign Up Membership Registration Form Dear Prospective Member, We are glad to have you join us. Kindly fill the form below. To complete your registration, you shall be redirected to payment portal to enable you pay the necessary registration fee of NGN15,000.00 (which covers registration and 1 year annual dues). Your membership certificate shall be sent to the email address you use for this registration, after successful payment. Welcome to the ASN!______________________________________________Username *account_circleEmail *emailProvide a functional email address: your details will be sent to this email.Password *visibilityChoose a password you can easily remember.Title *Indicate your preferred title. You can edit later if the need arises.Your Names *perm_identityProvide your government registered names, which will appear on your membership certificate.perm_identityGender *Brief Biography *Provide a brief about yourself under the following: Institutional Affiliation & Address: Area of Specialization: Professional Title/Designation: Phone number: Type of Membership (Student, Ordinary or Corporate Membership):Are You An Existing Member? *Answer "Yes" if you have been issued a membership certificate previously, or if you have attended and registered as a participant in any of our conferences. Otherwise, "No".My Photo *Upload an image of yourself, preferably a passport size or portrait, not more than 1MB.If you are having any challenges with filling this form, kindly call for support on +2348061311074. An existing member? Login
