Application for Registration/Re-Registration as a PractitionerPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2PART I PARTICULARS OF APPLICANT *RegistrationRe-RegistrationName *FirstLastEmail *Sex (Tick where applicable) *FemaleMaleDate of Birth *Place of Birth *Nationality *National Registration Card No *Place of issues *Date of issues *Physical address *Postal address *Telephone No *Mobile Phone No *NextEDUCATIONAL BACKGROUND School, Technical College or University attended *Qualification *Other QualificationSelect Category of membership *General MembershipAssociate MembershipStudent MembershipFellow MembershipFirm MembershipSection DividerPART II EMPLOYMENT RECORD Present Employment *Name of employer, Position held, Date of appointment and Nature of work undertaken.Previous Employment *Name of employer, Date/period employed, postion held and Nature of work undertaken.Section DividerAttach copies of all certificates (must be certified copies) * Click or drag a file to this area to upload. Attach a Proof of payment * Click or drag a file to this area to upload. Declaration *I Agree to the Terms and ConditionI declare that the information furnished by me in this application is true, correct and complete to the best of my knowledge. I understand that any incorrect, misleading or untrue information or the withholding of any relevant information may affect my registration as a practitionerVerify if you are Human * = Submit
