SELECT ONE MEMBERSHIP CORRESPONDENT LEGAL AID SOLICITOR COMMUNITY POLICING
First Name
Other Names
Title
Date of Birth
Marital Status
Nationality
Local Govt Origin
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Mobile Phone
Home Phone
FAX
E-mail
URL
Are you a Registered Member of JLERO?
Yes		No
Has your right ever been abused by the Police or any Law enforcement agent?
Yes		No

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. I authorize the confirmation and verification of ALL claims on this form.

Full Name

Date

Important Information:

The Justice and Law enforcement reformation organization is a non-governmental organization built on Justice, Knowledge and Integrity. Your support for an independent and incorruptible Judiciary and Law Enforcement system is the foundation for a sustainable socio, political and economic growth of Nigeria.