Application Form
Jaycees Malaysia Senate Association
MEMBERSHIP APPLICATION FORM
To:The Honorary Secretary,
Jaycees Malaysia Senate Association
I hereby apply for admission as an “ Ordinary / Associate / Honorary Member “ of your Organization and I agree to abide by the Constitution and By-law of the Organization.
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JCI Senator No. |
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NRIC No: |
Date of Birth: |
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Date of Birth: |
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Occupation |
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Marital Status |
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Office address: |
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| Home address: | ||
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E mail address: |
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Home Tel: |
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| Highest office inJC Career | ||
| LOM Member:Which LOM |
I hereby pledge my service through active participation in JCM Senate projects and I enclose herewith cheque No.__________________For RM _____________________.
Being entrance fee for Entrance Fee and Annual Subscription.
| Classification | Entrance Fee | Annual Subscription |
| Ordinary member | RM 150.00 | Nil |
| Associate member | RM 300.00 | Nil |
| Honorary member | RM1,000.00 | Nil |
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( Signature of Applicant )
Date:
Please E mail this Application to: The current year’s Secretary General JCI Sen. D J Lourdes djlourds@streamyx.com
or Fax: 03-79831442