Membership Application Form

Please fill out the Application Form below to apply for a new membership of the PeMSAA Australasia. After completing and submitting the application form, you will be redirected to Online Payment Form for your new membership . However, please note that the membership will only be granted if you are eligible and agree to the Privacy Policy and Terms & Conditions of The PeMSAA Australasia.

Applying as a
GraduateAcademic
Prefix (Dr./Prof.)

Surname (required)

Given Names (required)

Date of Birth (required)

Address (required)

Country (required)

Work Affiliation

Contact Details

Your Email (required)

Office Telephone

Mobile Telephone

Year of Entry of University of Peradeniya

Student ID

Proposed by (Name of a known Alumni)

Date of Application (required)

Portrait Photo (max res: 1200px*800px, max size 1Mb, jpg recommended)

Optional Details
Spouse

Children

PUBLISH BIO-DATA ON PEMSAA AUSTRALASIA WEBSITE

Your consent to publish your name, email address and mobile phone number on the Member Registry at PeMSAA Australasia
Email AddressOffice PhoneMobile Phone


NOTE The Member Registry can only be accessed by authenticated PeMSAA Australasia members via My PeMSAA Login and not open to general visitors of the site. Consented members will be given a user name and a password to access the Member Registry

Thank you for completing the Membership Application Form. After submitting the application form, you will be directed to the Common Online Payment Form where you can select many other options in addition to pay only for membership registration, including;
1. Pay for registration for PeMSAA congress in Adelaide 12-14 October 2018, additional accompanying persons, meals and gala dinner tickets
2. Pay for pre-congress tours
3. Pay for post congress tours (when available)
4. Pay for Channa Upuli and BnS cultural show