Registration /Membership Form

ZAMBIA MEDIA WOMEN ASSOCIATION

MEMBERSHIP FORM

NAME(IN FULL):…..…………………………………………………………………….

MARITAL STATUS:……………………………………………………………………..

ORGANISATION:…………………………………POSITION:…………………………

ADDRESS:…………………………………………………………………………………

TELEPHONE(OFFICE):…………………………………………………………………

RESIDENCE:…………………………………………………………………………….

E-MAIL ADDRESS:……………………………………………………………………….

PROFESSIONAL QUALIFICATIONS:……………………………………………….

………………………………………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………………………

(OR. ENCLOSE C.V)

HOBBIES/INTEREST:………………………………………………………………….

……………………………………………………………………………………………..

PURPOSE FOR MEMBERSHIP:……………………………………………………….

………………………………………………………………………………………………

………………………………………………………………………………………………

SIGNATURE:…………………………………DATE:…………………………………..

Application must be accompanied by a recent passport size photograph.
Registration fee is K50, 000=00-Annual Membership fee.

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