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 . CinaIndian . India

Other Bumiputera . Bumiputera Lain Others . Lain-lain      

Education . Pendidikan No formal educationTiada pendidikan formal

Primary education Pendidikan sekolah rendah

Secondary educationPendidikan sekolah menengah

Tertiary educationPendidikan 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 StatusStatus 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 Recipient’s Signature

KL & SELANGOR

Tandatangan Ahli _________________ Tandatangan Penerima _________________

U3AMF/201203/v.5.01/ETA

Submission and Payment Instructions . Arahan Penyerahan dan PembayaranPlease 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: u3aklsel@gmail.com

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 Selangorc/o Institute of Gerontology . d/a Institut GerontologiUniversiti Putra Malaysia 43400 UPM Serdang, Selangor, Malaysia