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 Online Payment Form where you can complete the application process by paying the membership fee.