ORSA Application Form

OLD RAJANS SCOUT ASSOCIATION

 

LAKE VIEW PARK INTERNATIONAL SCOUT CENTER

DHARMARAJA COLLEGE, KANDY

 

MEMBERSHIP APPLICATION FORM

 

Full Name: ……………………………………………………………………………………….

 

National ID/ Pass Port No:……………………………………………………..….…………….

 

Work Place/Institution:………………………………………………….………………………

Designation:……………………………………………………………………….…………….

 

Address (Private)                                             (Official)

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Tel No:……………………                             Tel No:……………………..

Fax No:…………………..                              Fax No:…………………….

Mobile No:……………….

Email:……………………                               Email:…………………….. 

 

Period you were a scout at Dharmaraja : From …………………to…………………

 

Highest Award Achieved (in scouting) :………………………Year………………..

 

Are you involved in Scouting Now? If So details :…………………………………

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Any Other Relevant Details :…………………………………………………………

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I`m enclosing a cheque /MO/ No ……..for Rs 1000- as the life membership fee.

 

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Date     :                                                                                   Signature

 

(PS : You may deposit the membership fee direct to account no 31664 at Bank Of Ceylon Super Grade Branch –Kandy titled as OLD RAJANS SCOUT ASSOCIATION and attach the bank counterfoil  to the application.)

 


FOR OFFICAL USE ONLY

 

This application was approved at the Ex co Meeting held on …………………..

Membership No allocated :…………………

 

………………                        …………………..                  …………….. 

Hon President                           Group Scout Leader                 Hon Secretary

Date :                                       Date:                                        Date: