Membership Application Form

Please fill in ALL the fields for your application to be expedited.

Date:

To the Honorary Secretary
Oxford & Cambridge Society, Malaysia
c/o Sharon Saw (Phone/Fax no: 03 – 20944995)
369 Lorong Maarof, Bukit Bandaraya
59000 Kuala Lumpur

I wish to apply for membership of the Oxford and Cambridge Society, Malaysia.

I will send my non-refundable membership fee of RM100,
by Cheque no: (payable to "The Oxford and Cambridge Society, Malaysia") to the address above.

I declare that I have for: term(s) at , and that the information I provide below is true, accurate and complete:

Title :
Surname :
First name (s) :

NRIC :  
for non-Malaysians,
Passport number		 : Country:
Home Address :
Mailing Address
(If different from home address ) 		:

Telephone Numbers
Mobile

:
Office :
Home :
Email Address
Please send notices by email 		:
College :
Dates of Residence :
Degree(s)/Program(s) :

Name of spouse,
if married

 :

I agree that :

(a) the above information is not confidential and may be used for the purposes of the Society, and I will promptly notify the Society of any changes;
(b) I will produce relevant documents promptly on request;
(c) the Committee of the Society need not give any reason for rejecting my application; and
(d) by submitting this application, I will be bound by the above terms and conditions and the Rules of the Society in force from time to time.

Agree Disagree

 

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