SWADAA MEMBERSHIP FORM

DRUGS ABUSE REHABILITATION ADVOCACY INITIATIVE (RC 6896175)

ACCREDITED NDLEA

MEMBERSHIP FORM

1. FULL NAME:

2. SEX: Male Female

3. CONTACT ADDRESS:

4. RESIDENTIAL ADDRESS:

5. NEAREST BUS STOP:

6. DATE OF BIRTH:

7. PLACE OF BIRTH:

8. STATE OF ORIGIN:

9. LOCAL GOVERNMENT AREA:

10. LOCAL GOVERNMENT AREA OF RESIDENCE:

11. TOWN:

12. NATIONALITY:

13. IF AN ALIEN (STATE REGISTRATION NO):

14. MARITAL STATUS:

15. NAME OF SPOUSE / PHONE NUMBER:

16. RELIGION STATUS:

17. EDUCATIONAL QUALIFICATIONS / YEAR OF QUALIFICATION:

DECLARATION

I, HEREBY PROMISE THAT I WILL OBEY ALL INSTRUCTIONS AND REGULATIONS OF THIS COMMISSION...

SIGNATURE:

GUARANTOR 1

NAME:

OCCUPATION:

ADDRESS:

PHONE NUMBER:

EMAIL ADDRESS:

GUARANTOR 2

NAME:

OCCUPATION:

ADDRESS:

PHONE NUMBER:

EMAIL ADDRESS:

OFFICIAL USE ONLY

THE ABOVE APPLICANT IS / NOT HAD BEEN QUALIFIED AND THEREFORE HEREBY ADFASED / DISFASED INTO SOCIAL WATCH ANTI-DRUG ABUSE ADVOCACY (SWADAA).

18. DO YOU BELONG TO ANY OTHER ORGANIZATION BEFORE NOW? Yes No

IF YES, NAME OF THE ORGANIZATION:

19. HAVE YOU EVER BEEN CONVICTED BY ANY COURT? IF SO, GIVE DETAILS:

20. REASON(S) FOR JOINING THIS ORGANIZATION:

21. OCCUPATION:

22. PHONE NUMBER:

23. EMAIL ADDRESS:

NOTE: SUBMIT THE FORM WITH A PHOTOCOPY OF A VALID ID AND 4 RECENT PASSPORT PHOTOS WITHIN 2 WEEKS