ASEAN Learning Network Individual Membership Registration Form
Kindly complete this form to become an individual member in ASEAN Learning Network. Please note that individual memberships are for the fiscal year beginning July 1 through June 30. Please submit your membership application and payment (*upon membership acceptance) within the fiscal year.
*Please note that membership registration does not amount to membership acceptance. You will be notified of membership acceptance within five working days after registration submission.
Email address *
Title (Dato'/ Datuk/ Prof/ Assoc Prof/ Dr/Mr/Ms) *
Your answer
First Name *
Your answer
Last Name/ Family Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Nationality *
Identity Card/Passport No. *
Your answer
Mobile Phone No. (please include country code)
Your answer
Correspondence Address *
Your answer
Organization *
Your answer
Position *
Your answer
Address of Organization *
Your answer
Office Phone (if any)
Your answer
Office Email (if any)
Your answer
Personal Email *
Your answer
Highest Academic Qualification *
Major subject(s) read at a university (while as undergraduate and/or post-graduate student) *
Your answer
Teaching Subjects (for faculty or former faculty member of university) *
Your answer
Type of Registration *
If your registration is based on existing ALN member's recommendation/ invitation, please kindly indicate his/ her name.
Your answer
Compliance *
Required
Payment of membership fees (CHF20/year) can be directly transferred to
Bank Name: UBS Switzerland AG
Bank Address: Postfach 1917, 4601 Olten, Switzerland
Beneficiary Name: Asean Learning Network
Beneficiary Address: Peter-und-Paulstrasse 46, 9010 St Gallen, Switzerland
IBAN: CH43 0026 1261 1108 4040 D
Account number: 261-110840.40D
SWIFT/BIC: UBSWCHZH80A
Please email the payment slip to admin@aseanlearningnetwork.org
*Please note that membership registration does not amount to membership acceptance. You will be notified of membership acceptance within five working days after registration submission.
A copy of your responses will be emailed to the address you provided.
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