Registration – IdomaUSA.org

REGISTRATION FORM

Name *

First

Last

Home Address

Phone Number (Whatsapp)

State

Country Of Residence

REGISTRATION CATEGORY

Individual Registration
Student Registration

Beneficiary 1 *

First

Last

*IMPORTANT:* Please provide four beneficiaries to ensure reliable contact during emergencies, urgent situations, or in the unfortunate event of death.

Relationship

Phone Number

Percentage

Beneficiary 2 *

First

Last

Relationship

Phone Number

Percentage

Beneficiary 3 *

First

Last

Relationship

Phone Number

Percentage

Beneficiary 4 *

First

Last

Relationship

Phone Number

Percentage

CONSENT & AGREEMENT (YOUR NAME)

By submitting this form, I confirm that all information provided is true, accurate, and valid. I agree to abide by the Constitution, By-Laws, rules, regulations, policies, and Code of Conduct of Idoma Association USA. I give the Association consent to use my photograph, video, image, likeness, or voice captured during official activities for publicity, social media, promotion, documentation, and outreach. I understand that violating the rules or providing false information may result in disciplinary action or termination of membership. I accept these terms. I consent to the use of photographs and videos taken during the convention for promotional purposes by Idoma Association USA.

I agree to abide by the rules and regulations *