Colombo University - Faculty of Science Alumni Association of North America (CUFSAA-NA)- Membership Form
Hello!

This form is to collect membership data from those who seek CUFSAA-NA membership.

Membership is open to alumni, and/or former faculty and staff members of the Science Faculty of the University of Colombo, Sri Lanka living in North America (USA, Canada, and Mexico). Your responses are secure and will be used only for the purposes and objectives of this Association.

Our plans are to organize additional activities in the future. Please fill out this survey to keep informed about CUFSAA activities through newsletters, bulletins, and emails.

Please forward the link of this survey to your fellow Science Faculty Alumni and encourage them to fill out the survey and become CUFSAA members.

Here is the link to the Survey to pass along to your contacts: https://goo.gl/forms/nBOt2H0KOMxDc7Q73

Thank you for your support!

CUFSAA-NA Executive Committee

[Expected time to complete the survey is less than 5 minutes.]
CUFSAA Membership Form
Let us know how to get in touch with you so that we can include you in our membership list.

Thank you!
1. Your Title *
Choose all that apply.
Required
2. Your First Name *
3. Your Last Name *
4. Your Preferred Email Address *
5. Your Alternate Email Address (if any)
6. Your Preferred Phone Number
Please include area code and type. e.g. (330) 123-4567 (Home).
7. Your Alternate Phone Number
Please include area code and type. e.g. (330) 123-4567 (Mobile).
8. Your Postal Address
Please provide full postal address which is preferred, but optional.
9. Your State/Province of Residence *
10. Your Country of Residence *
11. Nature of Your Association with the Faculty of Science of the University of Colombo, Sri Lanka. *
e.g. Tell us if you were a staff member, undergraduate student, graduate student, etc.
12. Duration of your association with the Faculty of Science of the University of Colombo, Sri Lanka. *
Please let us know the beginning and ending year of your association. e.g. If you graduated from the university in 1984, please answer 1984. Those who earned PhDs, masters, or certificates degrees from the Science Faculty, please enter the degree program and the year of graduation.
13. References
Please name any CUFSAA member OR current or former Colombo University Science Faculty academic staff member we may contact as a reference to verify your stated association with the Faculty of Science of the University of Colombo, Sri Lanka, if necessary.
14. Additional Remarks
Please include your area of study, whether you are interested in volunteering/serving in CUFSAA organization/committees, and your skills and abilities that could be of use to CUFSAA, etc.
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