Arahan/Instruction:Sila lengkapkan dan kembalikan ke alamat seperti di bawah. Anda akan menerima kad keahlian anda dalam tempoh satu ke dua bulan
Please complete and return to the address below. You will receive your membership card within one to two months
Maklumat Peribadi / Personal Information
Nama/ Name:
Gelaran/ Title:
No. Kad Pengenalan/ IC No.:
Jantina/Gender :
Tarikh Lahir/ D.O.B.:
Status Perkahwinan/ Marital Status:
Kolej
Latar Belakang Pendidikan Di UPM/ Education Background in UPM
Item Program/ Programme Fakulti/ Faculty Tahun/ Year
Diploma
Bacelor
Master
PhD
* Sila sertakan satu salinan sijil pengajian terkini di UPM / Please enclose a copy of the current education certificate in UPM
Alamat Tetap/ Permanent Address
Poskod/ Postcode :
Daerah/ District :
Negeri/ State:
Pekerjaan/ Profession
Organisasi /Organisation :
Jawatan/ Position:
Alamat/Address
No. Tel /Tel. No: No. Tel Bimbit /HP No. :
E-mel / E-mail: No. Faks/ Fax No. :
Alamat Perhubungan/ Contact Address
Alamat Tetap/ Permanent Address
Alamat Organisasi/ Organisation Address
Borang KeahlianMembership Form
Keahlian / Membership
Ahli Seumur Hidup / Life Member (Alumni UPM/ UPM Alumni) • RM50.00
Ahli Bersekutu / Associate Member (Staf UPM/ UPM’s Staff) • RM50 / Tahun / Year
Cetak Semula / Reprint • RM10
Kaedah Pembayaran / Payment Method
Cek / Cheque No. Cek / Cheque No.
Wang Pos / Postal Order Nombor / Number
Cek/ kiriman wang boleh dibayar atas nama “Persatuan Alumni UPM” No Akaun CIMB 8002150285Cheque/ postal order payable to “Persatuan Alumni UPM” CIMB Account No. 8002150285
Untuk Kegunaan Pejabat / For Offi ce UsePermohonan diluluskan / Application approved, Tidak diluluskan / Not Approved
Tarikh diluluskan / Approve date : ______________________ No. Keahlian / Membership number : _______________________
*Sila Sertakan bersama “Business Card” anda.
*Please attach your Business Card.
Persatuan Alumni UPM (PAUPM)Aras Bawah, Bangunan Canselori Putra, Off Lebuh SilikonUPM Serdang 43400 Serdang SelangorT : 03 8946 7242/ 7243/ 7244E : [email protected] : http://www.alumniupm.my
Tunal / Cash Tandatangan / Signature