You are on page 1of 2

Association of National Technology Sri Lanka.

Application for the association memberships.



www.nct-tech.edu.lk

80/3, Malwatta Rd, Hokandara South,Hokandara. T/P: 0773613399 Email: nctassociation@gmil.com

Membership No: _ _ _ _ / _ _ / _ _ _ _ (only for office use)


Applicants NIC No: .
1. Required associate membership:
(a) Student Membership (STM) : ( )
(b) Employee Membership (EMM) : ( )
(c) Honorable Membership (Hon.M) : ( )

2. Applicants relevant Engineering field.


(a) Civil Engineering CE ( )
(b) Electrical & Electronic Engineering EE ( )
(C) Mechanical Engineering ME ( )
(d) Quantity Surveying QS ( )
3. Personal details:
3.1 Name in full:.
3.2 Name with initials: .
3.3 Date of birth: Date.. Month: Year:
3.4 Postal Address:
3.5 Contact No: Home Mobile: ..
3.6 Email address:
4. Technical / Vocational education background.
Institute Course of study Duration From To
1.
2.
3.
4.
5.

4.1 Index Number of NCT final certificate (for employee members): ............................

4.2 Technical College /COT and students ID number (for student members): ......................................

5. History of applicants careers.

Employer Position held From To
1.
2.
3.
4.
5.
6. Special training programs obtained in relevant technical / vocational field. Yes ( ) No ( )
If yes:
7. Educational back ground.
7.1 School attended
(a)
(b)
(c)
(d)
(e)
7.2 Attended to G.C.E Ordinary Level ( )
7.3 Did you attend to G.C.E Advanced Level Yes ( ), No ( )
If yes 7.3 (a) Bio Science ( )
7.3 (b) Mathematics ( )
7.3 (c) Commerce ( )
7.3 (d) Arts ( )

8. Special activities of applicant: Teaching, Presentation skill, Singing, Dancing, sports, web designing,
IT skill, Photographing & etc.

9. Are you a blood donor? Yes ( ), No ( )


9.1 If yes, your blood group: ..
Note: As a charity service, association plan to help patients who need blood for urgent surgeries
and other medical treatments.
Do you like to save valuable lifes, please join us as a blood donor.
Do you like to register as a blood donor on our data base?

10. Declaration:
I wish agree to get the membership of Association of National Technology Sri Lanka as a Student
Member/Employee Member/ Honorable Membership from the date of ..
(Payment date for the membership). All my details are true and correct.
And I shall assist to develop & lead the association to higher level and agree to terms & conditions of
ANT SL.



Date: Signature: ...