Membership Registration Form 1. Code: 2. Surname: 3. Other Names: 4. Gender: Male Female5. Date of Birth: 6. Email: 7. Phone Number: 8. Place Of Assignment: 9. State: 10. Local Government Area 11. Permanent Address: 12. Old NANNM Card Number: 13.Nursing & Midwifery Council (RN License Number) 14.Nursing & Midwifery Council (RM License Number) 15. Date of Employment: 16. Years of Experience: 17. Expected Year of Retirement: 18. Add Qualifications/Years: 19. Areas of Specialization: 20. Capacity Building (Workshops/Seminars with dates) 21. Upload Passport: 22. Check reCaptcha: Send
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