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Membership Form pdf .pdf


Original filename: Membership Form_pdf.pdf
Title: Membership Application Form
Author: dell

This PDF 1.5 document has been generated by Acrobat PDFMaker 11 for Word / Adobe PDF Library 11.0, and has been sent on pdf-archive.com on 19/04/2017 at 10:26, from IP address 78.100.x.x. The current document download page has been viewed 240 times.
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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


Membership Form_pdf.pdf - page 1/2
Membership Form_pdf.pdf - page 2/2

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