Java St Andrew Society
Founded 1919
PLEASE PRINT CLEARLY
Qualification for Membership
FULL or LIFE Membership is open to anyone born in Scotland or who has any parent or grandparent born in Scotland. Anyone who does not qualify for FULL or LIFE membership is welcome to join as an ASSOCIATE Member. (Please mark relevant box/es below.)
| FIRST MEMBER | SECOND MEMBER |
| Surname: | Surname(if different): |
| First Name: | First Name: |
| I am of
Scottish birth One parent/grandparent of Scottish birth and I wish to apply for FULL MEMBERSHIP LIFE MEMBERSHIP |
I am of
Scottish birth One parent/grandparent of Scottish birth and I wish to apply for FULL MEMBERSHIP LIFE MEMBERSHIP |
| I do not
qualify as above but wish to wish to apply ASSOCIATE MEMBERSHIP |
I do not
qualify as above but wish to wish to apply ASSOCIATE MEMBERSHIP |
| Subscriptions: Joint Membership Rp. 150,000 per couple (Full or Associate) |
| Single Membership Rp. 100,000 per couple (Full or Associate) |
| Life Membership Rp.
300,000 per member (only applicable to Full members) or Rp 500,000 per couple (only applies to Full members) |
| RESIDENCE Please send mail here | COMPANY Please send mail here |
| Postcode:
_____________________ Tel:_________________________________ Fax:_________________________________ E-Mail ______________________________ Handphone __________________________ |
Postcode:
_____________________ Tel:_________________________________ Fax:_________________________________ E-Mail ______________________________ Handphone __________________________ |
| Interests: (The
Convenors will be happy to answer any questions regarding
these activities when you join) Golf (Handicaps: : ) Soccer Badminton Squash Snooker Scottish Country Dancing |
| Other interests (Please state): |
| Entertainment: Please
tick below if you are interested in entertaining at JSAS
events (Ceilidh, Burs Supper, etc.) Singer Musician (Instrument: ) MC Speaker Other |
| Accommodation: Are
you willing to host overseas guest participating in the
Jakarta Highland Gathering (Last weekend of May) and/ or
the St Andrew’s Ball (Late November)? NO &127 YES Number of Guests: Non Smoking |
| I/We can offer the following accommodation:- Double: Twin: Single: |
I/we enclose RP . cash7 or crossed cheque # (payable to JSAS) being the fee for year ending December (Please note that Subs are renewable in January).
| Signature
|
Date: |
| Proposed by:
|
Seconded By: |
(Only Full or Life Time members may propose or second your application. If you do not know any, leave blank and Committee members will sign)
This form together with the appropriate fee should be returned to the Membership Secretary:
Michele Robertson JL Ampera Raya 116A, Gg Sawo II, Cilindak,. Tel.780 6804.
Em: clanrobertson@attglobal.net