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JESSIE RIPOLL PRIMARY ALUMNI ASSOCIATION (JRPAA) MEMBERSHIP REGISTRATION FORM

BIOGRAPHICAL INFORMATION *TITLE: Mr.___ Miss___ Mrs.___ Dr.___ Rev. ___ *SURNAME: __________________________ MAIDEN NAME: ___________________ *FIRST NAME: _______________________*MIDDLE INITIAL[S]: ____________ *DATE OF BIRTH [DD/MM/YR]: _____________ *PREFERRED MAILING ADDRESS: Street ____________________________________________________ City/Town ____________________________________________________ Postal Office/Code ___________________________ State/Parish ___________________________ Country _______________ *OCCUPATION: _______________________________ *EMAIL: _________________________ EMAIL [OTHER]: ________________________ PHONE NUMBER[S]: *Home __________________ Work _________________ *Mobile _________________ Other __________________ BLACKBERRY PIN ______________________ *YEAR GRADUATED[From Jessie Ripoll Primary School]/CLASS OF: __________ PAYMENT METHOD Please Tick your Payment Option *1. WHEN Per Month___ Per Annum___ *2. HOW Cash___ Cheque___ Direct Deposit___ Wire Transfer___ Cheque Please make your cheque payable to Jessie Ripoll Primary Alumni Association. Direct Deposit You can deposit the money directly at any Jamaica National Building Society (JNBS) branch once you use the JRPAAs account #11124676. If you choose this option youll have to present us the receipt. You may also choose to do a standing order from your own account. To do this you will need to fill out a separate form from JNBS and give to your bank (ask us for this form). Bank: ____________________________________________ Branch Code: ________________________ Account #: _______________________ Type of Account: _______________________ For direct deposit, use the following account details: Bank: Jamaica National Building Society (JNBS) Account Name: Jessie Ripoll Primary Alumni Association Account #: 11124676

Wire Transfer If you live outside of Jamaica this may be an option for you to pay your yearly dues. Please see the following webpage for further details JNBS FAQs: Wire Transfers

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*I hereby solemnly acknowledge that all the information I have given above is completely true to the best of my knowledge and declare that I shall abide by the Constitution and By-Laws of the JRPAA. ____________________________ SIGNATURE FOR JRPAA OFFICE USE ONLY Registration Received ___ Date ___/___/___ Payment Received ___ Date ___/___/___ Receipt Issued ___ Date ___/___/___ Membership Number _________________ Passport Photo Received ___ Date ___/___/___ ________________________ DATE

JNBS WIRE TRANSFER INFORMATION Executive Officer _____________ Date ____________

INSTRUCTIONS 1. If writing, please print in bolded capitals using black or blue ink. 2. For the Biographical Information; Title and the Payment Method; WHEN & HOW please tick on the corresponding line the option that applies 3. Please respond to all the questions that have an asterisk [*] beside it. [However if you have no home or mobile number put N/A (Not Applicable)] 4. Please enclose one passport sized photo so we can include it in the records. 5. The annual dues are subject to change over time. [Presently the annual dues are JM$3,600 and JM$300 monthly]. Please view the exchange rate here: http://www.boj.org.jm/ 6. A registration is considered completed when all the questions with an asterisk are completed, when a passport sized photo is included and when a payment is made. 7. Leave the area marked FOR JRPAA OFFICE USE ONLY blank. 8. Please allow us seven [7] business days to issue your membership number and receipt for proof of payment. DISCLAIMER: All the information given is held under the strictest confidentiality and that information is upheld under ARTICLE 14: Member Database & Confidentiality of the JRPAA Constitution.

CONTACT INFORMATION
ADDRESS: Jessie Ripoll Primary Alumni Association St. Peter Claver Library, Jessie Ripoll Primary School, 26 South Camp Road, P.O. Box 8221, Kingston CSO (876) 928-1024 | (876) 930-1812-3 || FAX: 928-1617 thejrpaa@gmail.com http://www.facebook.com/thejrpaa http://www.twitter.com/jrpaa

TEL#: EMAIL: FACEBOOK: TWITTER:

LAST UPDATED OCTOBER 2012

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