NICOS Membership Registration Form

Society of Cosmetic Scientists Nigeria Membership Registration

Complete the form below to sign up for NICOS membership.
Title (Mr, Mrs, Dr, Professor etc) *
Name *

First Name Last Name
Gender *
Birth Date: *

Month Day Year
Professional Membership and grade (Name of organisations e.g. Royal Society of Chemists, MRSC)
EDUCATION AND ACADEMIC QUALIFICATIONS Please provide your start and completion of study years. Name of Educational Institution, Class, Major, and qualification obtained. Please state your most recent one first.

Home Address:

Street Address

Street Address Line 2

City State / Province/County

Postal / Zip Code Country
Country
E-mail *
example@example.com
Mobile Number: *

Area Code Phone Number
Employer/Company Name (if applicable)
Please add a CV, or any documents you feel will support your application. Please update with current employment, Name of Employer, Business nature, company position and duties/responsibilities.

Cancel of
Employer/Company Address:

Street Address

Street Address Line 2

City State / Province/County

Postal / Zip Code
Country
Employer/Company E-mail
Work/Company Phone Number:

Area Code Phone Number
Preferred Address for Correspondence? *

Home Work
If you selected other, please provide more information

If you selected other, please provide more information
Where did you hear about the Society *
colleague, friend, online, other
Declaration *

If my application is successful, I undertake to uphold the Constitution and Rules of the Society and do my utmost in my power to promote the welfare and maintain the dignity of the Society for as long as I continue to be a member. I confirm that the information given on this form and any attachment is correct to the best of my knowledge.
Data Protection

If you do not wish the Society to publish personal information you have supplied please tick the box. Please email societyofcosmeticscientistsng@gmail.com for a copy of the Society's privacy policy.
REFERENCES

It is the applicant’s responsibility to get in touch with the referee/sponsor and request an email response to be sent to societyofcosmeticscientistsng@gmail.com to confirm they know the applicant, in what professional capacity based on the requirements for NICOS membershipand for how long. Referees shall not be relatives.The progress of the application will commence when the referee response is received by the NICOS Secretary General. Any delay will result in the application being deferred to a future meeting of the NICOS Council.
Name of Referee *

First Name Last Name
Referee Occupation *
Relationship with Applicant *
Phone number
Please include country code (e.g. +234)
Email *
example@example.com
Company/Institution and Address

Street Address

Street Address Line 2

City State / Province/County

Postal / Zip Code
How long have you known the Referee *
In what capacity *

Now create your own JotForm - It's free! Create your own JotForm

Society of Cosmetic Scientists Nigeria Membership Registration

Current Course (students only)

Membership Package