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QIA Membership Application Form

Full Name:

*

Date of Birth

*

Gender

*

Gender

Male

Female

Prefer not to say

Place of Birth

*

Nationality

Adress:

*

Street

Postal Code, City

*

Country

*

Phone Number

*

E-Mail Address:

*

Current Occupation

*

Field of Expertise

*

How would you like to contribute to QIA's mission? (Check all that apply)

*

How would you like to contribute to QIA's mission? (Check all that apply)

Volunteering for events or initiatives

Offering professional expertise

Networking & partnerships

Fundraising & donations

Administrative or digital support

Other:

*

Membership Type:

*

Membership Type:

A

Regular Member (Eligible for full participation and voting rights)

B

Youth Member (Under 18 – consent required from guardian)

C

Honorary Member (Invitation only – do not select)

Consent & Declarations

*

Consent & Declarations

I affirm that all information provided is accurate and true to the best of my knowledge.

I understand and accept the rights, responsibilities, and conditions of membership as outlined in QIA's statutes.

I agree to actively support QIA’s mission and activities.