29
Sep
11

PCORE MEMBERSHIP FORM

 

 

 

 

 

 

ASSOCIATION OF VOICES OF PEACE, CONSCIENCE & REASON

 

 

Membership Application Form

Membership Fee : Ordinary Member RM50; Associate Member RM25

 

  1. Name: ………………………………………………………………………………………………… ……………….

 

  1. Title (honorary, education etc): …………………………………………………………………………………   

 

  1. Sex (please tick): Male ………  Female ……….       

 

  1.  I C No: ……………………………………………..       

                                                          

  1. (i) Address (home): …………………………………………………………………………………………………                     

              …………………………………………………………………………………………………………………………….

             Postcode: …………………………………………..    City: ……………………………………………………….

             (ii) Address (work):…………………………………………………………………………………………………..

             …………………………………………………………………………………………………………………………….

            Postcode: …………………………………………….   City: ……………………………………………………..

  1. Tel no (home): ……………………………………..  e mail: …………………………………………………..

                        (work): ……………………………………… 

                        (mobile): ……………………………………

  1. Command of languages: Good / Fair                  Written                       Spoken  

Malay                                                                ……………                     …………….    

             Chinese                                                            ……………                     ……………

             Tamil                                                                ……………                      ……………      

             English                                                             ……………                      ……………       

             Others                                                              ……………                      ……………

 

  1. Occupation:….. ……………………………………………………………………………………………………………

 

  1. Membership in political parties/trade unions/voluntary bodies: ………………………………………….. 

             …………………………………………………………………………………………………………………………………. 

  1. 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.

 

  1. 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 

 

  1. Applicant’s Signature:……………………………………………………………………………………………………

Date: ………………………………………………………….

  1. 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:………………………………………………………………..

Advertisements

0 Responses to “PCORE MEMBERSHIP FORM”



  1. Leave a Comment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


September 2011
M T W T F S S
« Aug   Oct »
 1234
567891011
12131415161718
19202122232425
2627282930  

Pages


%d bloggers like this: