Application Form for Membership

29 08 2009
Zanzibar Institute for Research and Public Policy

Application Form for Membership

Application Fee: TZS 1000/= Residents

USD 5.00 Non Residents

Please type or print your answers in the space provided below:

Part 1: PERSONAL INFORMATION

Sex (Male or Female)
First and Middle Name(s)
Surname
Current Occupation
Marital Status
Country of Residence

Permanent Address

P.O.BOX/Postal Code

E-mail Address
Mobile Telephone Number
Landline Telephone Number
Name and Address of Employer
Part 2:  Supplementary Personal Information
Academic Qualifications
Past Employment
National ID or Passport Number
Country and Place of Issuance
Date of Issuance
Date of Expiration
Are you an active member of an NGO? If yes, give the name of the NGO concerned; and for how long?
What do you know about ZIRPP and who introduced you to it?
What motivated you to join ZIRPP?
What are your expectations in the event of your being enrolled as a ZIRPP member?
Do you have any suggestions in terms of making ZIRPP much more effective and efficient in implementing its aims and objectives? And, if yes, please put your comments in writing.

Part 3: PLEASE DO NOT MARK OR WRITE ON THIS SPACE

The applicant has been approved.
The Applicant has not been approved.
Reason(s) for applicant’s disapproval.
Has the applicant paid the application fee in the amount of Tshs……..or USD$………….?
In case of approval, the applicant must pay Registration Fee in the amount of Tshs……..or USD$……….
In case of approval, the applicant must also pay an annual membership fee in the amount of Tshs…………or USD$……………..
The applicant must be informed of the outcome of his/her application within two weeks of the receipt of the application.
Please e-mail the duly completed application form to: yussufm@gmail.com

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