SAUA Membership Application Form

SAUA Membership Application
Please fill-in this form and send your payment to the address below. You will be contacted at the address(es)/number(s) you are to provide below (whichever deemed fit). Applications not followed-up with payment within 30 days will be annulled and disregarded.

1. PERSONAL DETAILS

Name

Date of Birth

Home Address

Postcode

Telephone

Office

Evening

Hand phone

Fax Number

Email Website

2. ACADEMIC RECORD

Qualification(s) Received
Please submit copy of qualifications certificate
when making payment

University / Institute / College
Format:
Qualifications certificate, establishment

Qualification(s) received on (dates)
Format:
Date, establishment, qualifications certificate

3. OCCUPATION

Company

Position

Company Address

If unemployed, state type of job preferred

4. GENERAL

Sports Played

Hobbies

Introducer by (SAUA member)

Other Association(s) Joined

Other Comments
(e.g. preferred SAUA activities)

I hereby certify to my best
knowledge that the above
particulars are correct and
that I shall abide by the Rules
and Constitution of the
"Sarawak Alumni of the
University of Adelaide."

Signed X Date :

<- please sign by typing in your name

NB. FEES: Entrance RM10, Annual Subscription RM20, Life Membership (Include Entrance) RM150. Cheques shall be made payable to "Sarawak Alumni of the University of Adelaide".

UPON COMPLETION, please forward form with payment to:

Post / Walk-in:
1st Floor Lots 2066-2067
Jalan Utama, Pending
93450 Kuching, Sarawak. (payment)
Fax : (+60 82) 482999
Tel : (+60 82) 483888 / 483999
Web : http://www.saua.net
E-mail : rodgerc@tm.net.my

FOR OFFICIAL USE

Application Received on

By Whom

Discussed During Executive Meeting on

Approved?

Payment Amount Received

Membership No

Official Receipt No