200B Isale Eko Avenue, Dolphin Estate, Ikoyi, Lagos, Nigeria wimbiz@wimbiz.org

Associate Membership

REGISTER

Instructions: carefully read through the form before filling. Only duly completed forms with attached CVs and passport photographs will be processed.

Kindly attach 2 recent passport sized photographs

HIGHEST EDUCATION LEVEL ATTAINED (Please tick as Appropriate):

'O' Levels OND HND B.Sc Masters PhD

PROFESSIONAL QUALIFICATIONS AND AFFILIATIONS (PLEASE LIST):

1.
2.
3.

WORK EXPERIENCE (in Yrs.):

0-3 4-7 8-11 12-15 16-19 20 and above

Have you attended any WIMBIZ event? (Please state how many times you have attended each event?):

1. Roundtable Lunch 2-6 times 7-9 times 10 + times
2. Annual Conference 2-6 times 7-9 times 10 + times
3. Annual Lecture series 2-6 times 7-9 times 10 + times
Are you a WIMBIZ Mentor? Yes No
Are you a WIMBIZ Mentee? Yes No
I hereby declare that the information herein to the best of my knowledge and belief is correct.
Note:
  • Read the Terms and conditions of WIMBIZ membership at www.wimbiz.org.
  • Applicant must have attended at least 2 WIMBIZ events.
  • Each application will be considered on its own merit.
  • Changes regarding any of the information supplied in this Application Form should be communicated to the WIMBIZ Secretariat.
  • Associate membership does not confer any voting rights within WIMBIZ.

Please send a completed copy of this form, your recent passport photograph (hard copy or JPEG file format) and a 2-page CV to:

WIMBIZ Secretariat, 200B Isale Eko Avenue, Dolphin Estate, Ikoyi, Lagos
Or email to jumoke@wimbiz.org and copy wimbiz@wimbiz.org.

For Enquiries, please call 08106396789

Visit our website at www.wimbiz.org

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