Become A Member

ASSOCIATION OF MARRIAGE AND FAMILY COUNSELLORS, NIGERIA

(Please Write in Block Letters Clearly)

MEMBERSHIP APPLICATION FORM

The following information are necessary for record purposes.

Date

Member No

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1. PERSONAL

Surname

Firstname

Middlename

Official Mailing Address

Home Address

Date of Birth

GenderMaleFemale

Religious Affiliation

Religious Certification/ordination

Educational qualification(s)Diploma/CertificateNigeria Certificate in Education (NCE)National Diploma (ND)Higher National Diploma (HND)Bachelor’s Degree (B.Sc, B.A, B.Eng, LL.B, B.Ed, MBBS, etc.)Postgraduate Diploma (PGD/PGDE)Master’s Degree (M.Sc, M.A, MBA, M.Ed, etc.)Doctor of Philosophy (Ph.D)

Other Qualifications

2. CURRENT PROFESSION

a. ORGANIZATION

Address

Position

b. AMFC (ASSOCIATION OF MARRIAGE AND FAMILY COUNSELLORS)

ARE YOU A PRACTICING COUNSELLOR ?YesNo

HOW LONG ?

What skills, interest, etc do you bring as a member ?

How do you wish to be involved in AMFC ?

A. Have you ever been under disciplinary action by any professional organization or licensing boardYesNo

If Yes Explain

B. Have you any court convictionYesNo

C.Divorcee/Single ParentWidow/WidowerStable Marriage (wife &husband)Stable Marriage (Polygamy)

Others, please state

D. How long have you been marriedLess than 10 yrs10-25yrs25-40yrsabove 40yrs

III. STATEMENT OF COMPLIANCE

I understand my responsibilities as a Certified Marriage and Family Counsellor, and membership in the Association of Marriage and Family Counsellors, Nigeria (”AMFC”), including my obligation to abide by all the statutes, constitutions and bye-laws of the association.

Upload Signature and Date

Tick	Date

Application grantedThick

Date

Membership certificate issuedThick

Date

Basic Counseling training attendedThick

Date

CV & credentials receivedThick

Date

Passport photograph attachedThick

Date

Official Verification

Name

Status