ASSOCIATION OF VOICES OF PEACE, CONSCIENCE & REASON
Membership Application Form
Membership Fee : Ordinary Member RM50; Associate Member RM25
- Name: ………………………………………………………………………………………………… ……………….
- Title (honorary, education etc): …………………………………………………………………………………
- Sex (please tick): Male ……… Female ……….
- I C No: ……………………………………………..
- (i) Address (home): …………………………………………………………………………………………………
…………………………………………………………………………………………………………………………….
Postcode: ………………………………………….. City: ……………………………………………………….
(ii) Address (work):…………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………….
Postcode: ……………………………………………. City: ……………………………………………………..
- Tel no (home): …………………………………….. e mail: …………………………………………………..
(work): ………………………………………
(mobile): ……………………………………
- Command of languages: Good / Fair Written Spoken
Malay …………… …………….
Chinese …………… ……………
Tamil …………… ……………
English …………… ……………
Others …………… ……………
- Occupation:….. ……………………………………………………………………………………………………………
- Membership in political parties/trade unions/voluntary bodies: …………………………………………..
………………………………………………………………………………………………………………………………….
- If you are accepted as a member of PCORE, which two (2) of the following areas would
you like to be involved in? Please tick 2
- Community networking and neighbourliness.
- Celebrating diversity and interfaith relations.
- Synergising the school and home in the education of the young.
- Creating a robust environment for improving health and wellness.
- Uplifting socio-economic status through education and training.
- Sustaining and preserving the natural and cultural heritage.
- Promoting effective language and communication strategies.
- Ensuring fairness, justice and legal equity.
- Building integrity and ethical standards.
- Consolidating national integration and unity.
- I have read PCORE’s Aims and Objectives given below and accept them:
(i) T o establish effective channels and linkages for peace building efforts at the personal, community and organisational levels
(ii) To promote a dynamic vision for nation building and development that optimises shared resources, talents and skills among diverse groups
(iii) To develop a substantive body of oral and written discourse built upon moral conscience and reason on issues of public concern at public forums, in the media, on the internet, in reputable journals and magazines and other relevant channels
(iv) To implement meaningful programmes and activities that promote the personal and group needs and interests of its members and members of the bigger community
- Applicant’s Signature:……………………………………………………………………………………………………
Date: ………………………………………………………….
- Proposer:……………………………………………………Seconder:…………………………………………………
Please send completed forms via post to: Hon Secretary PCORE,
7 Jalan Damansara, Permai, Damansara Heights, 50490 KL
via email to: halimahms@hotmail.com
__________________________________________________________________________
FOR OFFICE USE ONLY
Applicant’s name:………………………………………………………………
Date application received:…………………………………………………
Payment : cash/ cheque no:……………………………………………….
Registration no:………………………………………………………………..