LIFIN ASSOCIATESHIP PROGRAMME
MEMBERSHIP FORM
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Full Name *
Email Address *
Name of University/ Work  Place *
Level/Designation *
Legal Status *
Required
Sex *
Relationship *
Home Town *
L. G. A *
State *
Religion *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Phone Number *
Why do you aspire to become a LIFIN ASSOCIATE? *
I hereby attest that the information provided here is accurate *
Required
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