The Peranakan Association Singapore Application for Life Membership

Name

NRIC Nationality Date of Birth (ddmmyy)

Home Address
Postal Code

Tel (H) Hp Pg Fax

Email

Office Address
Postal Code Tel (O) Fax (O)
Email

Marital Status (if married) Name of spouse

Occupation

Are you a Peranakan? Yes No

(If yes) Are you a Peranakan on maternal side paternal side both

Applicant's Signature ______________________ Date ______________________

Proposer Membership No. Signature __________________

Seconder Membership No. Signature __________________

For Official Use Only

Membership No. __________________ Date of Approval __________________

Receipt No. _______________ Bank ___________ Cheque No. ______________

Honorary Secretary ____________________________________
 
PRINT
 
Please fill out this membership form and send it with your cheque of $128
Attn to: Hon. Secretary The Peranakan Association Singapore
Raffles City P.O.Box 1640, Singapore 911755

We will notify you by email upon receipt, but we will need to table your application at the next committee meeting. Thank you.