Japura Alumni Australia Inc

Membership Application Form

Membership of Japura Alumni Australia Inc. is open to all past students/employees of the University of Sri Jayewardenepura, Sri Lanka.

Three types of membership are offered by our constitution. (Please select one)

Membership type	Amount payable	Selection
Life Membership* Membership for life for you ($10 joining fee + $100 life membership fee)	$110.00
Life membership-Family* Membership for life for you and your family ($10 joining fee + $110 life membership fee)	$120.00
Ordinary membership* Your membership is valid only after receiving annual membership fee by 30th June each year. You pay $10 joining fee + $10 annual fee every year thereafter.	$20.00

Please Select Membership Type

Full Name

Please complete the First Name

Middle Name

Last Name

Tittle

Home Address

Phone (Home)

Phone (Mobile)

Please Enter the Mobile Number

Email Address

Please Enter the Email

Membership of Professional/ Associations or your business associations:

In which calendar years and department did you study/work at the University of Sri Jayewardenepura:

Do you agree your personnel details above are published in Japura member’s directory (online and paper based publications)

Yes No

Please Select agree or not

Password

Please Enter the Password

Re Password

Please ReEnter the Password

Methods of application/Payment

1. Complete this form and hand over/email to any one of the current Committee members

2. Complete this application and send scanned copy by e mail to our e mail address japuraalumni@gmail.com

3. Login to our website, www.japuraalumni.org to create a member’s account and complete this form online (available from Oct 2016)

4. Pay appropriate fee directly in to our bank account. BSB: 013-471; A/C No. 4776-46618. Account name; Japura Alumni Australia Inc

I wish to become a member of the Japura Alumni Australia Inc. and certify that the above particulars are true and correct. In the event of my admission as a member, I agree to be bound by the rules of the Association.