Church/Mosque rural subscription

<p>Dear esteemed member/partner, kindly pay your annual subscription fee plus the one-time registration fee if you haven't done so already.</p>

Church or Mosque rural subscription

Please pay your annual membership obligation.

Rural Church/Mosque subscription *

Annual subscription for Churches/Mosques in rural areas - ₦ 500.00

Please renew my membership automatically.

One-time unit registration fee

One-time unit registration fee - ₦ 1,000.00

Total Amount

Email Address *

I am making this payment on behalf of the school.

On Behalf Of Organization

Organization Name *

Phone (Main) *

Email (Main) *

Street Address *

City *

Postal Code *

Country *

State/Province *

Name and Address

First Name *

Last Name *

Mobile Number *

Passport-sized Photograph

Date of Birth (DoB) *

Career/Profession

Division/LGA (Residence/Guiding) *

Nationality

State (Guiding/Residence) *

Street Address (Guiding/Residence) *

Postal Code (Guiding/Residence)

Department/Thematic Area You can Function

Other: Your areas of talent/expertise not captured above if any.

Medical Conditions

Let us know if you have any medical condition you think you should be aware of, especially if you are physically challenged.

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