Membership

Anambra Great Minds Associations

Port-Harcourt Headquarters

(Motto; Progress, Unity & Service)

ADMISSION FORM

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Title

Name

First

Last

Date Of Birth

Marital Status

Religion

Residential Address

Address Line 1

City

State / Province / Region

Occupation

Business Address

Phone Number

L.G.A

Town

Village

Are You in Your Town Union Meeting here in PHC YES/ NO

If YES, when did you join

What is the Name and Phone number of your Town Union Chairman here in PHC

Are you in any other committee of friends or Association (Club) here in PHC? YES/ NO

If YES, mention the Association (Club) and your position if any

Why do you want to join AGMA?

Will you abide by the rules and regulations of AGMA YES/ NO

Next Of Kin

Next of Kin Name

Address of Next of Kin

Occupation of Next of Kin

Phone Number

SPOUSE

Spouse Name

Spouse Phone Number

Spouse e-mail

Spouse Business Address (If Any)

GUARANTOR

Guarantor’s Name

Guarantor’s Address

Guarantor’s Phone No

Declaration

Terms

I Hereby declares that if admitted into this Great Association, henceforth I will be a devoted member of AGMA and participate in every activity for the upliftment of AGMA so help me God.

ANAMBRA GREAT MINDS ASSOCIATION – Progress