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*

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