Membership Details Update Form

Please fill out the Membership Details Update Form below to update your information, if you are an already a member of PeMSAA Australasia. By submitting this form, you agree to the Privacy Policy and Terms & Conditions of The PeMSAA Australasia.

Membership Number

Member Since (mm/dd/yyyy - required)

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

Surname (required)

Given Names (required)

Date of Birth (mm/dd/yyyy - 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 (mm/dd/yyyy - 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 Details Update Form.