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Sustainable Consumption & Production Forum Sri Lanka (SCP Forum Sri Lanka)
Membership Application
ApplicationCategory :
Individual member
Life Member
[01] Name of Applicant:
[02] Date of Birth:
[03] NIC / Passport Number:
[04] Private Address:
[05] Contact Details - Land Phone:
Mobile:
e-mail:
[06] Academic Qualifications:
[07] Professional Qualifications:
[08] Requirements for SCP Forum membership (refer Guidelines to Application for Membership,details to be given above):
[09] Name and address of present employer:
[10] Present Position:
Working From (Date):
Telephone:
Mobile:
e-mail:
[11] Please give a brief description of your present duties and responsibilities:
[12] Address for Communication (Private/Official):
Telephone:
Mobile:
e-mail:
[13] Previous employment:
[14] Details of SCP programs followed by the applicant:
[15] Details of SCP Programmes the applicant has been involved in. (Please state the specific responsibilities of the applicant and the benefits accrued to the organization):
[16] Other experience in SCP activities :
[17] Motivation and the intention of joining the SCP Forum :
[18] Could contributefor the achievements of SCP Forum’s objectives by propagating the SCP concepts among (Please mark “✓” the category/categories) :
General public
Media personnel / community
Policy makers
Business community
School children
Youth
Academia
NGOs / CBOs
Housewives
Religious establishments
[19] could also contributefor the achievements of SCP Forum’s objectives by providing the following services (Please mark “✓” the service/s) :
Improvinginternational relations
Improving government relations
Providing legal support
Providing administrative or logistical supports
Website development
ICT support
Fund raising
As an event organizer
As a resource person for SCP workshops / seminars / conferences
For the application of research knowledge
[20] My main priorityfor engagements / contributions shall be for (Please mark “✓” the priority area/s):
Sustainable consumption
Sustainable production
Both sustainable consumption and production
[21] Any other relevant information in support of thea pplication:
[22] Proposer :
Name of the Member :
Present Position :
Signature Date :
[23] Seconder :
Name of the Member :
Present Position :
Signature Date :
[24] Declaration by the applicant :
I, the undersigned hereby apply for t h e membership in the SCP Forum of Sri Lanka as an Individual / a Life Member and undertake to abide by the constitution and by-laws of the Forum.
I am enclosing cash/cheque payable to“SCP Forum Sri Lanka” for Rs.1,000 as the Admission fee and Rs.
as my annual subscription fee for
year(s) individual / life membership.
Date
Signature of Applicant
Official use only
I .
Date received
Payment included
Amount (LKR)
If Cheque Payment, Cheque No./ Bank
Receipt No.
Acknowledgment letter
Interview date (if required)
Approval date
Minutes confirmed
Acceptance letter date
Computer feeding
II .
Date received
Approval of Membership Panel
Chairman
Member
Member
Signature of the President
Class of membership
Submit