VIOBA Membership Application June 26, 2010 admin Uncategorised Name (required) Title ---Tan SriDato'Dr.Mr.MadamMs. NRIC No. Date of Birth Email Address (required) Home Address Tel No. Business Address Business Tel No. Business Fax No. Last Year in Victoria Institution Vehicle Registration No. Please direct all correspondence to ---OfficeResidence Type of Membership (required) ---Ordinary (RM24 per year)Life (RM300 one time) Enclosed herewith cash/cheque (To be drawn in favour of VIOBA) Cheque No. / Amount I hereby confirm that I was a student/staff of the Victoria Institution. On admission, I agree to abide by the Rules of the Association. * Application will be processed only when relevant membership fee is made. A membership package will be posted to you on acceptance of your application. All Life and Ordinary members are also members of the VIOBA Foundation. Agree Proposer's Name Membership No. You may also print the form to submit by hand.