REGISTRATION FORM

Title

Mr.
Mrs.
Ms.
Dr.
Chief

Name *

First

Last

Date of Birth

WHAT AGE CATEGORY DO YOU FALL UNDER?

18-30years
31-40years
41-50years
51years and Above

POSTAL ADDRESS:

City

State

Mobile Number

Email *

SKYPE ID

WHATSAPP OR TELEGRAM NUMBER

LINKEDIN LINK

INSTAGRAM LINK

INTERESTS: Example- Mentoring, Training, Researching, Fitness e.t.c

ADDITIONAL INFORMATION

PLEASE SELECT YOUR PREFERRED CONTACT METHOD

COMPANY NAME

COMPANY EMAIL

OFFICE ADDRESS

POSITION HELD

BUSINESS ACTIVITIES RELATED TO THE ENERGY INDUSTRY

Please select your membership type- Individual Membership : Open to all women who work in the energy space and have minimum of 3 years of experience. Affiliate Membership : Restricted to government agencies.

Individual Membership ₦55,000.00
Honorary Membership: By Selection
Affiliate Membership: By Selection

Individual Membership

For Individual membership, please send a reference letter from your HR and endorsement/signature by a current member of WIEN

ARE YOU INTERESTED IN SERVING IN ANY OF THE EXECUTIVE LEADERSHIP COMMITTEE?

Please indicate if your are member of other associations such as: SPE, NSE, APWEN, EI, COREN NAPE

Please specify who you are regulated by: such as DPR, NIPEX,If others, please specify________

File Upload- Personal Profile *

Click or drag a file to this area to upload.

Please upload your Personal Profile in pdf. (File should not exceed 6MB)

File Upload- Letter of Commitment *

Click or drag a file to this area to upload.

Please upload your Letter of Commitment in pdf. (File should not exceed 6MB)

File Upload - References *

Click or drag a file to this area to upload.

Please upload your References in pdf (File should not exceed 6MB)

File Upload- Passport Photograph *

Click or drag a file to this area to upload.

Please upload your Passport Photograph. (File should not exceed 6MB)

Payment Date (Leave Blank)

Membership Registration Form