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Registration Form

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Registration Form

ZAMREN MEMBERSHIP REGISTRATION FORM

Name of Institution

Physical Address

Postal Address

Total Number of Students

Number of Regular Students

Number of Long Distance & evening Students

Head of Institution's Name

Head of Institution's Contact

Head of Institution's Email Address

Head of Institutions's Signature (Image)

Head of Technical Dept's Name

Head of Technical Dept's Contact

Head of Technical Dept's Email Address

Accountant's Name

Accountant's Contact

Accountant's Email Address

Procurement Officer's Name

Procurement Officer's Contact

Procurement Officer's Email Address

Attach your Tax Clearance Certificate (PDF)

Tick the services you are interested in:

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If you have not selected any field from the above, kindly specify what service(s) you are interested in below (max 10 words):

Where did you hear about ZAMREN?

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If none of the above options apply, please specify the platform through which you heard about ZAMREN (max 10 words):

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OFFICIAL ADDRESS

Zambia Research and Education Network (ZAMREN), The ZAMREN House, Off Kamloops Road, University of Zambia, P.O. Box 32379, Lusaka, Zambia.

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