Please note the following:

You are expected to have paid the due amount for your preferred membership type before proceeding with this form, as you would be required to input your payment details in the field below.

Account Details

Make your Membership payment to by following the transfer instruction below:

Beneficiary Bank: zenith bank plc
Beneficiary Bank Swift Code: zeibngla

Intermediary Bank:
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)

Beneficiary: Initiative for Cognitive Therapies and Mental Health
Account Number: 507……

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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