University of the Third Age, KL & SelangorHak dan Faedah Keahlian Rights & Benefits . Hak & Faedah...
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University of the Third Age, KL & Selangor MEMBERSHIP REGISTRATION FORM . Borang Pendaftaran Keahlian Please complete the following form in duplicate for membership record-keeping purposes: Sila lengkapkan borang berikut dalam dua salinan untuk simpanan rekod keahlian: 1. Personal Details . Butiran Peribadi Name . Nama IC No. . No. K/P Title . Gelaran Tun / Tan Sri / Pn. Sri / Dato’ / Datin / Prof. / Dr. / Mr. / Mrs. / Ms. Date of Birth . Tarikh lahir (dd/mm/yy) Sex . Jantina Male . Lelaki Female . Perempuan Ethnicity . Etnik Keturunan Malay . Melayu Chinese . Cina Indian . India Other Bumiputera . Bumiputera Lain Others . Lain-lain Education . Pendidikan No formal education Tiada pendidikan formal Primary education Pendidikan sekolah rendah Secondary education Pendidikan sekolah menengah Tertiary education Pendidikan kolej / universiti 2. Contact Information . Maklumat Perhubungan Mailing Address . Alamat Surat-menyurat City / State . Bdr./ Negeri Postcode . Poskod Hp. No. . No. Tel. Bimbit Tel. No. . No. Tel. Fax No. . No. Faks E-mail . E-mel 3. Emergency Contact Number . Nombor Hubungan Kecemasan Name . Nama Relationship . Hubungan Hp. No. . No. Tel. Bimbit Tel. No. . No. Tel. 4. Membership Category . Kategori Keahlian Membership Status Status Keahlian New . Baru Returning . Lama Lapsed . Terlucut Ordinary Member . Ahli Biasa (55+) [RM25 per year . setahun] Life Member . Ahli Seumur Hidup (55+) [RM150 one-time payment . sekali seumur hidup] Associate Member . Ahli Bersekutu (50-54) [RM25 per year . setahun] Note: A one-time membership processing fee of RM10 is applicable for new or lapsed members. Nota: Yuran pemprosesan keahlian sebanyak RM10 dikenakan sekali sahaja untuk ahli-ahli baru atau terlucut. FOR OFFICE USE . Untuk Kegunaan Pejabat Membership No. No. Keahlian Total Payment Jumlah Bayaran Date Tarikh Receipt No. No. Resit Member’s Signature Tandatangan Ahli _________________ Recipient’s Signature Tandatangan Penerima _________________ U3AMF/201203/v.5.01/ETA KL & SELANGOR
Transcript of University of the Third Age, KL & SelangorHak dan Faedah Keahlian Rights & Benefits . Hak & Faedah...
University of the Third Age, KL & Selangor
MEMBERSHIP REGISTRATION FORM . Borang Pendaftaran Keahlian
Please complete the following form in duplicate for membership record-keeping purposes: Sila lengkapkan borang berikut dalam dua salinan untuk simpanan rekod keahlian:
1. Personal Details . Butiran Peribadi
Name . Nama
IC No. . No. K/P
Title . Gelaran Tun / Tan Sri / Pn. Sri / Dato’ / Datin / Prof. / Dr. / Mr. / Mrs. / Ms.
Date of Birth . Tarikh lahir (dd/mm/yy)
Sex . Jantina Male . Lelaki Female . Perempuan
Ethnicity . Etnik Keturunan Malay . Melayu
Chinese . Cina
Indian . India
Other Bumiputera . Bumiputera Lain
Others . Lain-lain
Education . Pendidikan No formal education Tiada pendidikan formal
Primary education Pendidikan sekolah rendah
Secondary education Pendidikan sekolah menengah
Tertiary education Pendidikan kolej / universiti
2. Contact Information . Maklumat Perhubungan
Mailing Address . Alamat Surat-menyurat
City / State . Bdr./ Negeri Postcode . Poskod
Hp. No. . No. Tel. Bimbit Tel. No. . No. Tel.
Fax No. . No. Faks E-mail . E-mel
3. Emergency Contact Number . Nombor Hubungan Kecemasan
Name . Nama Relationship . Hubungan
Hp. No. . No. Tel. Bimbit Tel. No. . No. Tel.
4. Membership Category . Kategori Keahlian
Membership Status Status Keahlian
New . Baru
Returning . Lama
Lapsed . Terlucut
Ordinary Member . Ahli Biasa (55+) [RM25 per year . setahun]
Life Member . Ahli Seumur Hidup (55+) [RM150 one-time payment . sekali seumur hidup]
Associate Member . Ahli Bersekutu (50-54) [RM25 per year . setahun]
Note: A one-time membership processing fee of RM10 is applicable for new or lapsed members.
Nota: Yuran pemprosesan keahlian sebanyak RM10 dikenakan sekali sahaja untuk ahli-ahli baru atau terlucut.
FOR OFFICE USE . Untuk Kegunaan Pejabat
Membership No. No. Keahlian
Total Payment Jumlah Bayaran
Date Tarikh
Receipt No. No. Resit
Member’s Signature Tandatangan Ahli
_________________
Recipient’s Signature Tandatangan Penerima
_________________
U3AMF/201203/v.5.01/ETA
K L & S E L A N G O R
Submission and Payment Instructions . Arahan Penyerahan dan Pembayaran
Please forward the form with payment, a photocopy of your identity card and two (2) passport-sized photos to the following address:
Sila hantar borang ini berserta bayaran, salinan kad pengenalan dan dua (2) keping gambar bersaiz pasport ke alamat berikut:
Tel. : 603-89472755 / 2740 . Fax : 603-89472744 / 2738 . E-mail: [email protected] Note: All banker’s order / banker’s cheque should be made payable to “Persatuan
Pembelajaran Sepanjang Hayat Warga Emas U3A Kuala Lumpur dan Selangor”. Nota: Segala bayaran cek harus dibuat di atas nama “Persatuan Pembelajaran Sepanjang Hayat Warga Emas U3A Kuala Lumpur dan Selangor”.
Membership Rights and Benefits . Hak dan Faedah Keahlian
Rights & Benefits . Hak & Faedah
Ordinary & Life Member . Ahli Biasa & Seumur Hidup
Associate Member . Ahli Bersekutu
Conditions . Syarat Aged 55 years or over. Aged between 50 and 54 years.
Membership Renewal .
Pembaharuan Keahlian
Annually (Ordinary member). Life memberships are renewed automatically.
Annually (Associate member). New membership application is required for upgrade to ordinary member status upon the age of 55.
Annual General Meeting . Mesyuarat Agung Tahunan
Participate in proceedings.
Eligible to vote and be voted.
Participate in proceedings.
Not eligible to vote or be voted.
Courses . Kursus-kursus Upon course registration and payment before the semester begins.
Certificate Presentation Ceremony . Majlis Penyampaian Sijil
Members who participated in Semester 1 and / or 2 courses and invited guests.
Others . Lain-lain � Official blog - http://u3amalaysia.wordpress.com
� ThirdAge Info bulletin
� Talks, seminars and visits
� Other social activities or gatherings
Association for Lifelong Learning of Older Persons U3A Kuala Lumpur and Selangor
Persatuan Pembelajaran Sepanjang Hayat Warga Emas U3A Kuala Lumpur dan Selangor c/o Institute of Gerontology . d/a Institut Gerontologi Universiti Putra Malaysia 43400 UPM Serdang, Selangor, Malaysia
