MEMBERSHIP UPDATE FORM 2021
All respected members of IICEP are required to complete this registration form. Indicate any changes;
SECTION 1: MEMBER CONTACT INFORMATION (Please double click on the check box, go to ‘Default
Value’ then click on ‘Checked’ and click ‘ok’)
TITLE
Mr
Mrs
Miss
Ms
Prof
Dr
Others
NAME
ADDRESS 1
ADDRESS 2
TOWN/CITY
NATIONALITY
MOBILE PHONE
PRIMARY E-MAIL
JOB TITLE:
MEMBERSHIP TYPE
MEMBERSHIP NUMB
IICEP STATE
CHAPTER
For Membership descriptions see website https://www,thechartered.org/?m=1
SECTION 2: CAREER / VOCATION INFORMATION
(Please type on the column)
PROFESSION
NATURE OF
WORK
YEARS OF
EXPERIENCE
AREA OF CORE
COMPETENCE
EDUCATIONAL
DEVELOPMENT OF
INTEREST
SECTION 3: MEMBER INFORMATION
OCCUPATION / JOB TITLE:
Would you like to receive IICEP membership information? :
Yes
No
Have you participated in IICEP induction?
YES
NO
Other
Do you have IICEP Certificate? Y or N
If Yes, Give certificate No……………
Do you belong to any IICEP State chapter? Y or N
If no, would you want to subscribe?
Please indicate if you would be willing to serve on any chapter committee:
Yes
Not at this time
Is there a specific committee you would like to serve on? _________________________
Permission to use photographic images:
Photographs of IICEP members may be used in various IICEP communications incl. the newsletter and website.
Group photographs taken at IICEP events may be used without identifying individual members. For individual
photographs, please indicate your permission for use:
_____ IICEP has my permission to use and identify photographs of me.
_____ IICEP must contact me before using any identified photographs of me in IICEP communications.
Please submit a copy of your update form to Admin via watsapp on +234 907 471 7484 or info.iicep@gmail.com
Before 8th of March 2021