Unic - Membership application

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	Membership Application request
	Field marked * are mandatory
	Identification
	Lastname*:
	Firstname*:
	Date of Birth
	Profession
	Education:
	Other association or organization membership?	Check this box
	If Yes, name of your organization
	Leaving abroad - out of DRC ?	Check this box
	Your province of origin in DRC
	Address:*
	Zip Code:
	City*:
	Country*:
	Email:
	Telephone:
	Mobile - cellular phone
	Fax:

	Inscription
	Type of membership requested :*
	Are you interested of any electoral mandate?	Check this box
	If Yes, which election?
	Copy and paste your resume or Curriculum vitae - here	Copy and paste your resume or Curriculum vitae - here
	Comment:

	I’m hereby committing myself to respect the statutes and the internal rule leading Unic as organization based on an alliance between diverses partners for the best interest of our movement.

Membership Application request