Individual Membership Form

INDIVIDUAL MEMBERSHIP APPLICATION FORM

Note: To apply for NiMRA membership, please complete and submit this form. All submissions are subject to Board approval.
TYPE OF MEMBERSHIP REQUESTED*
[Please tick box as relevant]
- Full member
- Associate member
- Affliate member
- Student member
PERSONAL INFORMATION
Name*

Title

First

Last
Designation*
Phone*
Mobile Phone
Email Address*
Contact Address*

Street Address

City

State / Province / Region

ZIP / Postal Code

Country
Date of Birth*

DD slash MM slash YYYY
Upload your passport photograph*
Accepted file types: jpg, pdf, jpeg, Max. file size: 8 MB.
EDUCATIONAL QUALIFICATION
[Confirmation may be requested directly from your Instituition]
Highest Level of Education attained*
Highest Qualification/Certification*
Institution attended with highest qualification*
OTHER PROFESSIONAL MEMBERSHIPS
[List other professional associations you belong to]
CAREER HISTORY
Postion Held*
Organizaton*
Nature of Employer’s Business*
Duration of Service in this position*
TO*
Add more experience
- Yes
Postion Held*
Organizaton*
Nature of Employer’s Business*
Duration of Service in this position*
TO*
Add more experience
- Yes
Postion Held*
Organizaton*
Nature of Employer’s Business*
Duration of Service in this position*
TO*
Add more experience
- Yes
REFREE INFORMATION To be filled by every applicant)

Please provide details of ONE PERSON who can vouch for your integrity; this person must be a Marketing or Opinion Research Professional in an Agency or mid- to senior level management in Client business (that conducts Market Research, Insights or Brand Management or related fields).
Full Name of Endoser*
Business / Employer’s Name*
Designation*
Contact Address
Endorser’s Phone*
Endorser’s Email
Applicant*
- Applicant: I agree to abide by the self-regulatory rules of the Nigerian Marketing Research Association as spelled out in the so adapted ICC Code of Ethics and Guidelines.

INDIVIDUAL MEMBERSHIP APPLICATION FORM

PERSONAL INFORMATION

EDUCATIONAL QUALIFICATION

CAREER HISTORY

The Association

Support

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