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Name (Surname First) |
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Date of Birth |
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Sex |
Male: Female: |
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Marital status |
Single: Married:
Divorced: Widowed: |
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Academic discipline/field |
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Academic qualification (Highest) |
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Occupation |
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State of Origin |
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Town |
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Home Address |
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Office Address |
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Tel No |
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Email Address |
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Briefly state your interest in the Centre |
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Do you have any record of participation in activities and/or support for activities geared towards the development, promotion and use of Yoruba language?
Yes: No: |
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If yes, state briefly: |
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I _____________________________ agree with the objectives of the association and will abide by its constitution.