Academic Staff Union of Research Institutions (ASURI)

Registered Trade Union Cap 437

Membership Form

Branch

Branch/Chapter *

Personal Details

Full Name (Surname First) *

Email Address *

State of Origin *

Phone Number *

Date of Birth *

Sex *

Nationality *

Employment

IPPIS Number *

Current Rank *

Date of First Appointment *

Passport Photo (Image) *

Signature (Img, PDF, Doc) *

I voluntarily elect to be a member of ASURI under Section 40 of the Constitution of the Federal Republic of Nigeria. I certify that all information provided is correct and I pledge to abide by the rules and regulations of the Union.