Application Form

Centre for Ethical Rebirth Among Nigeria Youths ^®

Join CERANY

Name:*

Title

Surname

First name

Middle name

Date of Birth:

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Present Qualification*

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1ST REFERENCE

Name of Referee 1:*

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2ND REFERENCE

Name of Referee 2:*

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Surname

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Address of Referee 2*

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Hobby

Reasons for Joining CERANY*

UNDERTAKING

I with the particulars supplied above on my own volition do hereby affirm that I am a citizen of Nigeria and I undertake to abide by the provisions of the constitution, rules and regulations of Cerany and to be a good ambassador of the Centre in all situations and circumstances, to promote and advance the Cerany cause, and to jealously guard the integrity and collective image of the organization, for the overall good of fatherland. So help me God!

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