No.22, Udumulla Passage, Pagoda Road, Nugegoda, Sri Lanka
Tel: +94 (0)11 4737796  E-mail: info@theburgherassociation.com

 The Burgher Association

 

 

APPLICATION FOR MEMBERSHIP

1.  Full Name: 2.  Civil Status:
3.  Maiden Name: 4.  NIC No:
5.  Postal Address: 6.  District:
7.  Telephone/Fax (Res): 8.  Office:
9.  Email Address (Res): 10.  Office:
11.  Office Address:
12.  Applicant's Father's Name:
13.  Applicant's Mother's Name
14.  Name of Spouse: 15.  Maiden
      Name:
16.  Spouses Father's Name:
17.  Spouses Mother's Name: 18.  Maiden
      Name:
19.  Names of children
      under 18 Years:
20.  Proposed by: ________________________ Signature: _______________ Membership No: _______________
21.  Seconded by: ________________________ Signature: _______________ Membership No: _______________
22.  Amount paid Rs. ______________ (chq/cash)
23.  Receipt No: ______________
_____________________
Applicants Signature/Date
24.  Membership applied for: Individual/Family

Note:

a.  The Proposer and Seconder should be Full Members of The Burgher Association.
b.  Cheques should be drawn in favour of "The Burgher Association", crossed A/C Payee only and sent with the application
     to: The Treasurer, The Burgher Association, No.22, Udumulla Passage, Pagoda Road, Nugegoda, Sri Lanka.
c.  Annual Membership Fees:     Individual: Rs. 500/-      Family: Rs. 1,000/-
Overseas membership US$20 (or equivalent)
d:  Membership fees are subject to revision by the Governing Body.
e.  Applicants will be called upon to produce the originals of Certificates of Birth for scrutiny and return.
f.  Status of Membership: Full Membership will be granted to Burghers only.  Non-Burghers married to Burghers will be granted
    Associate Membership.
g.  Applicants wishing to have their profile and photograph on the internet, may attach same to the application.
-----------------------------------------------------------:: For Office use only ::-------------------------------------------------------
Approved by the Executive Committee on: ______________ at Ex. Co. Meeting No: _________
On the following basis: 01.  Applicant's Membership Status:               ____________      Membership No: _________
                                 14.   Applicant's Spouses Membership Status: ____________      Membership No: _________
_____________________
           Secretary
____________________
Date