PART A: PERSONAL INFORMATION

NAME
GENDER
RACE
DATE OF BIRTH PICTURE
PLACE OF BIRTH
IC NUMBER
ADDRESS
CONTACT NUMBER
EMAIL ADDRESS
CHURCH
MEMBERSHIP
PART B: ACADEMIC INFORMATION YEAR
SECONDARY SCHOOL INSTITUTION:
DIPLOMA INSTITUTION:
UNDERGRAD DEGREE INSTITUTION:
POSTGRAD DEGREE INSTITUTION:
SECONDARY SCHOOL
DIPLOMA
COURSE
UNDERGRAD DEGREE
POSTGRAD DEGREE
PERIOD OF STUDY (CURRENT): YEAR OF GRADUATION:
APPLICANT DECLARATION:
I__________________I/C number ____________________ hereby apply to become the member of Sabah Adventist
Association of College And University Student (SACUS) and admit that all the information I have provided are true.

Applicant’s signature, Proposer’s signature,

……………………………. ……………………………..
( ) ( )
DATE: DATE
FOR OFFICE USE
DATE OF RECEIVING APPLICATION FORM
MEMBERSHIP STATUS: ( ) ACCEPTED ( ) REJECTED
SACUS NUMBER:
Processed by,

……………………………..
( )

SABAH ADVENTIST ASSOCIATION

OF
COLLEGE AND UNIVERSITY STUDENT
MEMBERSHIP FORM
*Please enclose the copy of your IC and Matric Card.

SACUS Membership Form_bd_2010