Student/Junior Research Member (JRM) - Form

Fill/Update your registration form for submission

Student/Junior Research Member (JRM) Fee: ₦10,000.00

Passport

Bio Data

First Name

Middle Name

Last Name

Place of Birth

Gender

Male Female

Date of Birth

Marital Status

Nationality

State of Origin

Local Government Area

Next of Kin Name

Next of Kin Address

Current Postal Address

Residential Address

Email Address

Telephone

Educational Qualifications

Primary School

Primary School Year Passed Out

Primary School Certificate Obtained

Secondary School

Secondary School Year Passed Out

Secondary School Certificate Obtained

Higher Institution

Higher Institution Year Passed Out

Higher Institution Certificate Obtained

Higher Institution Course Offered

Higher Institution Final Grade

Second Degree (if any)

Professional Qualifications

Do you belong to any Professional Institute?

Yes No

If yes, Name of Institute

Your Status in the Institute

Membership Number of Institute

Year of Qualification

Declaration

I solemnly declare that all information given by me in this application form are true and correct, and I agree to abide by the rules, ethics and standards of ERIN.

Signature

Date