Please note the following:

Before proceeding to fill the membership form, you are required to first make the payment for your preferred membership type, as you would have to input the payment details in the form below.

Payment Instruction:

To make your Membership payment simply follow the instruction below:

Beneficiary Bank: zenith bank plc
Beneficiary Bank Swift Code: zeibngla
Beneficiary Account Name: Initiative for Cognitive Therapies and Mental Health
Account Number: 507……

Intermediary Bank Details:
Citibank N.A.
111 Wall Street, New York,
New York 10043
Intermediary Bank Swift Address: citius33
Intermediary Bank ABA No: 021000089
Intermediary Bank Account No: 36204566 (USD)

Diaspora Membership Form

Personal Info.

Professional Info. (For clinical professionals only)

Payment Details

Enter the details of the payment you made below (see payment details above):

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