Eurasians Community Centre - The Malaysian Eurasian people is a unique community that embraces almost every race that lives in Malaysia and we are proud to state that we are truly Malaysians who live in peace and harmony.

SELANGOR & FEDERAL TERRITORY
EURASIAN ASSOCIATION
167, JALAN PUDU
55100 KUALA LUMPUR

Life Membership Application Form

Name:
Date of Birth:
Address:
Tel. No.
Email:

N.R.I.C. No.:
Occupation:
Employer's Name
Employer's Address
Tel. No.

The Hon. Gen. Secretary
SAFTEA, Kuala Lumpur

Date:

Sir,

I wish to apply for Life Membership of Selangor & Federal Territory Eurasian Association. Enclose herewith RM 300.00/- being payment for Association Life Membership.

Should I be granted membership, I hereby undertake to keep my subscriptions in benefit, to discharge promptly any liabilities incurred by me, and conform to the Rules, By-Laws and other regulations as maybe adopted from time to time.

I further declare that under provisions of Rules 5 (a).

I am a Eurasian
I am of Eurasian descent
State which family member

Proposed by: Membership No:
Seconded by: MemberShip No:

Verify your entry

Enter Code shown above
Code not clear? Click here

Back | Forward | Top