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ALUMNI ASSOCIATION
                          Faculty of Applied Sciences, Rajarata University of Sri Lanka

                                          MeMbership ApplicAtion

General Information

 Full Name :                _________________________________________________________________________________

                            _________________________________________________________________________________


 Name with Initials :       (Mr./Mrs./Miss.) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                            _________________________________________________________________________________


 Permanent Address :        _________________________________________________________________________________

                            _________________________________________________________________________________


 Residential Address :      _________________________________________________________________________________

                            _________________________________________________________________________________


 Telephone :                ________________________________                             Mobile :             __________________________________


 Email :                    _________________________________________________________________________________


 Date of Birth :            ________________________________




Professional Information

 Designation :              _________________________________________________________________________________


 Office Address :           _________________________________________________________________________________

                            _________________________________________________________________________________


 Office Telephone :         _____________________________                            Office Mobile :                    _____________________________


 Office Email :             _________________________________________________________________________________




Graduate Information

 Batch / Year :             ___________________________                           Registration No :                       ____________________________



Membership Information

                Life Membership (One-time Payment – Rs. 5000/-)
                Ordinary Membership (Annual Payment – Rs. 500/-)
 (Account Details: National Saving Bank – Wallampitiya - Account No: 1-0706-77-0068-7)




 ______________________                                                                                                  _____________________________

         Date                                                                                                                           Signature

                           Membership No                                    Payment Received Date Authorized Signature
For Official Use Only

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Alumni application

  • 1. ALUMNI ASSOCIATION Faculty of Applied Sciences, Rajarata University of Sri Lanka MeMbership ApplicAtion General Information Full Name : _________________________________________________________________________________ _________________________________________________________________________________ Name with Initials : (Mr./Mrs./Miss.) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _________________________________________________________________________________ Permanent Address : _________________________________________________________________________________ _________________________________________________________________________________ Residential Address : _________________________________________________________________________________ _________________________________________________________________________________ Telephone : ________________________________ Mobile : __________________________________ Email : _________________________________________________________________________________ Date of Birth : ________________________________ Professional Information Designation : _________________________________________________________________________________ Office Address : _________________________________________________________________________________ _________________________________________________________________________________ Office Telephone : _____________________________ Office Mobile : _____________________________ Office Email : _________________________________________________________________________________ Graduate Information Batch / Year : ___________________________ Registration No : ____________________________ Membership Information Life Membership (One-time Payment – Rs. 5000/-) Ordinary Membership (Annual Payment – Rs. 500/-) (Account Details: National Saving Bank – Wallampitiya - Account No: 1-0706-77-0068-7) ______________________ _____________________________ Date Signature Membership No Payment Received Date Authorized Signature For Official Use Only