Online Registration

SRI LANKA COLLEGE OF VETERINARY SURGEONS
(SLCVS)
Registration No. GA 2976

APPLICATION FOR MEMBERS, ASSOCIATE MEMBERS AND FELLOWS

SLCVS Articles Extract regarding Membership

Personal

Name of the Applicant *

Qualifications (with dates and copies of academic certificates)

SLVC Registration No *

SLVC Reg. Date (YYYY-MM-DD) *

Date of Birth (YYYY-MM-DD) *

Contact information

Official Address *

Address for correspondence *

Email - Office *

Email - Personal *

Telephone - Office *

Telephone - Mobile *

Field(s) of specialization

Please specify

Type of Membership sought
(Please see the announcement for information on eligibility criteria for associate membership / membership / fellowship)

Associate Membership
Membership
Fellowship

Activities and contributions to the profession for the specified time period applicable for associate membership / membership / fellowship as in the eligibility criteria

Please specify

Information of Two (2) Non-related Referees

Referee 1

Name

Designation

Office Address

Office Telephone

Mobile No

Referee 2

Name

Designation

Office Address

Office Telephone

Mobile No

Enrolment Fee Payment Details

Payment Method *

Bank *

Ref. no. / Cheque no. *

NB:

Please attach a brief Résumé outlining academic and professional credentials, activities carried out in the veterinary and allied fields, and contribution made to the profession.
I have done the payment via above payment method for Rs , drawn in favour of the “Sri Lanka College of Veterinary Surgeons” as my enrolment fee. The evidence is attached.
Bank details:
Bank of Ceylon – Peradeniya,
Account Number – 77018496
Swift code – BCEYLKLX
Account Name – Sri Lanka College of Veterinary Surgeons
Please send the completed form, scanned PDF files of certificates and resume by e-mail to: srilankacollegevet@gmail.com
AND post the hard-copies of all documents to:
Dr. Namalika Karunaratne
Secretary, Sri Lanka College of Veterinary Surgeons,
C/o Office of the Dean,
Faculty of Veterinary Medicine and Animal Science,
University of Peradeniya.