Membership Form pdf (PDF)
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Title: Membership Application Form
Author: dell
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PLCC-FRM-0001-R0
PUTTALAM LAKERS CRICKET CLUB
APPLICATION FOR CLUB MEMBERSHIP
(USE ENGLISH BLOCK LETTERS TO FILL)
1. FULL NAME
:......................................................................................
:......................................................................................
2. NAME WITH INITIAL
:......................................................................................
3. PRESENT ADDRESS
:......................................................................................
:......................................................................................
4: PERMENANT ADDRESS :......................................................................................
:......................................................................................
4. DATE OF BIRTH:
YEAR:.............. MONTH:............ DATE:...................
5. AGE (as on date of application) :......................................................................................
6. NIC NO
:......................................................................................
7. CONTACT NUMBERS
:......................................................................................
8. WHATSAPP No.
:......................................................................................
9. E-MAIL
:......................................................................................
RECOMMENDATION
(To be filled by a Senior Player or EXCO member of Puttalam Lakers Cricket Club)
NAME
:......................................................................................
I hereby strongly recommend the applicant for admission in to the Puttalam Lakers Cricket
Club due to his good attitude, discipline and cricketing skills.
Signature & Date
Page 1 of 2
Puttalam Lakers Cricket Club
PLCC-FRM-0001-R0
I declare further details are correct and I confidently certify I role my attitude and behavior
throughout the constitution (Doc No.PLCC/PRO/0001/R0) of the PUTTALAM LAKERS
CRICKET CLUB. Finally, I well known my membership will be cancelled if my activities
changed against rules and regulation of the PUTTALAM LAKERS CRICKET CLUB.
Signature of Applicant
Date
FOR OFFICE USE ONLY
Classification
Membership Fee
Age below 21
Rs. 1,500.00
Age above 21
Rs. 2,500.00
Expatriates
Rs. 5,000.00
Remark
Application Checked By
Signature & Date
ACCEPTED
REJECTED
If rejected. Reason for rejection:
……………………….…………………………………………………………………………
………………………………………………………………………………………………….
Membership No:
P
L
C
CLUB CODE
C
Y
President
Page 2 of 2
Y
M
M
SERIAL No.
General Secretary
Puttalam Lakers Cricket Club
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