AFRICOM: MEMBERSHIP APPLICATION FORM


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AFRICOM Today || Resources || Museums in Africa || Join AFRICOM

MEMBERSHIP APPLICATION FORM

Please fill in the membership application form below:

Subject:

*First Name:

(Please incl. Mr. / Mrs. / Miss / Ms / Dr / Prof.)

*Last Name:

Date of Birth:

Date Month Year

Sex:

Male Female

Nationality:

*Name of Institution:

*Type of Institution:

(e.g. Natural History Museum)

Positon:

(e.g. Curator)

Department:

Professional Address:

(Please incl. Physical Address)

*City:

*Country:

Other Mailing Address:

(For Students / Honorary Members)

Office Telephone(s):

(Option 1)

(Option 2)

Fax:

Mobile Phone:

(Optional)

Home Telephone:

(Please incl. Country and Area Codes e.g. +254-2-374-8668)

Personal Email(s):

(Option 1)

(Option 2)

*Institutional Email:

Institutional Website:

Language for Correspondence:

English French

Language for Publication:

English French

Field of Basic Training:

Field(s) of Expertise:

Area(s) of Specialization:

Experience as a Trainer:

Degrees and
Honours received:

(Please incl. year)

Languages:

(Spoken)

(Written)

(Read)

Membership in other
Professional Organisations:

I am an ICOM member:

Yes No

*Category of Membership: (Tick one only) * Please submit supporting documents

Individual USD$10 Institutional USD$ 50

Associated USD$ 20 *Student USD$ 5

*Additional Remarks /
Information:

Please upload your current CV and photograph

*Indicate how many attachments to be uploaded:

(e.g. 1, 2)

Attachment 1:

(eg: Image / MS Word / PDF file) up to 200Kb

Attachment 2:

(eg: Image / MS Word / PDF file) up to 200Kb

I declare that I am eligible for membership of the International Council of African Museums (AFRICOM) and wish to become a member of AFRICOM. I do not engage in dealing (ie. buying and selling for profit) in the field of cultural property and accept the Code of Professional Ethics for museum professionals as adopted by the International Council of Museums (ICOM) and adhered to by AFRICOM.

NB: Membership is annual and runs from January 1 until December 31 of the year in which membership sought/fees paid. New memberships received after September 30th will become effective as from January 1st of the following year unless otherwise indicated.

AFRICOM WOULD LIKE TO ESTABLISH FREE ENTRY TO AFRICAN MUSEUMS AS PART OF THE BENEFITS OF MEMBERSHIP. PLEASE TRY TO ESTABLISH THIS IN YOUR COUNTRY AND CONFIRM TO AFRICOM SO THAT WE MAY KEEP MEMBERS INFORMED. THANK YOU!