Raffles Institution Parents’ Association

c/o 1 Raffles Institution Lane Singapore 575954

Email: rpamail@yahoo.com.sg

RPA Membership Application Form

Please complete the relevant section:
 Section A – For parents who have never been members of RPA.
 Section B – For parents who already are members of RPA (i.e. you have been a
member of RPA since your son’s secondary school days in RI.)
 Section C – For parents who wish to opt out of becoming members of RPA.
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Section A Membership Application

Member’s Particulars Spouse’s Particulars

Name Dr/Mr/Mrs/Mdm/Ms * Dr/Mr/Mrs/Mdm/Ms *
Surname/Family Name Surname/Family Name

Given Name Given Name

Occupation

Relationship Father/Mother/Guardian * Father/Mother/Guardian *

Email Address

Contact No.

Address

Postal Code:
Students’ Particulars
(1) _____________________________________________Class________
(2) _____________________________________________Class________

Level Subscription Fee ** Please Tick

RI Year 1 / 2 / 3 / 4 * $ Cash Cheque***
RI (JC) Year 5 / 6 * $ Cash Cheque***
* Delete as applicable
** Membership subscription fee: Entry at Year 1 is $60.00; Entry at Year 5 (JC) is $20.00
Fees for other entry year will be payable at $10.00 per year tenure of membership
***Cheques should be crossed and made payable to “RPA”

Please turn to the next page to indicate the activities you wish to participate
This portion to be detached for member upon payment
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Date : ____________________
Received from ________________________, $ _____ ( Cash / Cheque no.
_______________) being membership subscription fee for RPA.

________________________
Authorized Signature
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Member, please tick (S ) your interests in the boxes below
Raffles Institution (Secondary) Raffles Institution (Junior College)
Activities & Events Activities & Events
Annual Bowling Competition Ad Hoc Student Community Involvement
Golf Fund Raiser for RI / RJC A-Levels Pre Exam Dinner (10 Nights)
HM Lunch with RPA Members HM/Principal Lunch with RPA Members
Host Overseas Scholars for CNY Dinner A-Levels Prom Night Sponsorship
Interact Club Sponsorship Golf Fund Raiser for RI / RJC
Join RPA Management Committee JC 1 Orientation Talk by Principal
Joint RI-Parent Community Service Join RPA Management Committee
Library Volunteers National Day Celebrations
National Day Celebrations Old Rafflesian Association Family Day
Old Rafflesian Association Family Day Parent Resource for RJC OUTLOOK
Parenting Events - Socials, Talks, Outing Parenting Events - Social, Talks, Outing
Research Education Parent Mentor RJC Annual D&D Sponsorship
RI Annual Staff D&D Sponsorship RJC Take-Five Day
RI Interact Club CNY Dinner/Old Folks RJC Teachers Day Celebration
RI Open House Kopitiam RPA AGM (Lunch & Talk)
RI Teachers’ Day Celebration Sports Boy / Girl / Creative Arts Award
RPA AGM (Lunch & Talk) Student Service Centre Volunteer
RPA Sec 1 Welcome Event
RPA Level Networking Events
Sec 4 Academic Achievemen1t Sponsor
Sec 4 Graduation Night Sponsorship
Sec 1 Orientation Day
Sec 1 Subject Talks
Swimming Carnival Prizes
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Section B I am already a member of RPA

Name: _____________________________________________ Year joined:___________

Address: ___________________________________________

Contact no: ____________________E-mail Address:________________________________________

Child’s name: _____________________________Class:_______________

____________________________________________________________________

Section C Opt –out Form

I do not wish to be member of RPA. Details requested are as follows:

Name: ___________________________________________

Contact no: ___________________E-mail Address: _______________________________________

Child’s name:______________________________________ Class:_______________

Signature: _____________________ Date:_____________________

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