2017-2018 MEMBERSHIP APPLICATION FORM

1.Name: Click here to enter text.

2.Work Place Address: Click here to enter text.
Telephone: Click here to enter text.

3.Home Address: Click here to enter text.

4. Telephone: Mobile: Click here to enter text. Home (optional): Click here to enter text.

5.Email: Click here to enter text. 6. Job Title: Click here to enter text.

7.Availability for working visits to Ghana 2017(Voluntary/Optional) Proposed programme of visits to Ghana by MOTEC group in 2017: Please select preferred choice: Choose an item.

8.Subscription... £10/month or £100 per year (compulsory) Student Rate - free. You may have to solicit for sponsorship for working visits of Motec or self-sponsor. You also have to arrange annual/professional study leave with your employer. Working visits are aimed at training, education and transfer of skills. You are advised to declare to the trip team leader any special dietary restrictions prior to the trip to Ghana and also any special medical conditions for your own safety.

9. How would you like to be contacted: Choose an item. Other: Click here to enter text.

10.Which skills do you possess to support Motec's programme of activities UK/Ghana: Choose an item.
Others: Click here to enter text.

11.Any suggestions for Motec: Click here to enter text.

12.Do you have any criminal record(s) or any professional disciplinary issues in the pastor issues pending proceedings? Choose an item.

If YES, could you elaborate (on a separate sheet if necessary): Click here to enter text.

13.Any Hobbies: Click here to enter text.

14.a) Next of Kin: Click here to enter text.

b) Contact Details. Tel & email: Click here to enter text.

To the best of my knowledge, the information I have provided is true and accurate. I have a free choice to enjoy my membership fully without travelling to Ghana. I also understand that working visits are voluntary - there is no compulsion to travel to Ghana. Motec reserve the right to terminate my membership and or take the necessary steps. (To be signed in conjunction with agreement with the terms of the constitution). Prior to any trip with Motec, you may be required to complete a form that will not only help you prepare yourself well for the trip but also to obtain updated information about yourself.
Signature ______

Please return the completed signed form to the Membership Secretary (above address). You may also send a recent (6 months) photograph of yourself plus abbreviated C.V. by email to You will receive a confirmatory email to confirm the stage of your registration.

Chief Patron:Prof. Lord David Alton of Liverpool John Moores University, House of Lords, London. Co-Patrons: Mr Peter Dyson FRCS, Spinal Orthopaedic Surgeon, England; Mrs Marian Barnor, MRB Consult, Ghana President: Paul OforiAttaMB.ChB, FRCS; Vice President: Dr Louisa Draper M.A., MB.BS; Secretary: Mrs Kay Bowers;Membership Secretary: Mrs G. Ofori-Atta; Treasurer: Dr Raymond OforiWelfare Officer: Mrs Linda Bigham