MEMBER DATA UPDATE FORM /
APPLICATION FOR PLASTIC MEMBERSHIP CARD / E-MAIL ACCOUNT
The General Secretary
Old Bens Sports Club
383 K Cyril C Perera Mawatha, Colombo 13
Membership No:
*
Membership Type:
*
- Select -
Life
Ordinary
Associate
Special
Date of Issue:
*
Surname with initials:
*
First Name:
*
Profession :
*
Employer :
*
Office address :
*
How can you help add value to the Sports Club :
*
NIC No:
*
Mailing Address:
*
E mail Address:
*
Contact No:
*
Mobile No:
*
Do you wish to have an
E mail account issued
by the Club :
*
- Select -
Yes
No
Do you need the new
magnetic encoded
Plastic Membership Card:
*
- Select -
Yes
No
Attach One Photo Here "jpg" :
*
Date :
*
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