Membership Application Form

Seniors for Motherland

“Seniors for Motherland” is a group of volunteer public-spirited independent citizens aimed at making a positive contribution towards up-lifting economic and social well-being, good governance, social justice and rule of law and ethical and religious harmony in our motherland Sri Lanka.

A member can be any volunteer who wants to support us or receives our services, because they believe that what we do is important and meaningful.

Surname(required)

Other names(required)

Name with initials(required)

Country of birth(required)

Country of residence(required)

Telephone number(required)

Email(required)

Website (if any)

Address

Post code

Highest educational qualification

Membership of professional bodies

If professional status is "Other", please specify

Membership is free. Volunteer donations are accepted.

If willingness to donate is “Yes”, we will contact you to provide payment details.

Other Details (if any)

I accept that my details will be held on a secure data base and will not be passed to any third party without my permission.

Date