Membership Form

Membership Type *

Individual Life Member
Family Life Members

Title *

Name *

First

Last

Faculty/Postgraduate Institute *

Year Completed *

Postal Address *

Street Name, Street/unit number, Suburb, Postcode

Email *

Mobile Phone *

Other Phone

Details of the Spouse

Title

Telephone

Spouse is a Peradeniya Graduate

If yes,

A. Faculty/Postgraduate Institute

B. Year Completed

Membership Fee

Payment Mode: Direct deposit or Bank transfers only. Please contact PUAAN Treasurer via puaan07@gmail.com

Agreement

By submitting this online form I/we certify that the above information is true to the best of my/our knowledge and agree PUAAN Executive members to use contact details to communicate with me/us.