President - Deshamanya Prof. A. H. Sheriffdeen
President - elect - Deshamanya Dr. J. B. Peiris.
Vice - Presidents -
Prof. Rohan Jayasekara
Prof. Sanath. P. Laqmabadasuriya MBE
Vidyajothi Prof. Lalitha Mendis
Co - Secretaries
Prof. Athula Kaluarachchi
Dr. Saroja Siriwardene
Treasurer
Prof. Jennifer Perera
Asst. Treasurer
Dr. Piyusha Atapattu
Editor
Dr. B.J.C. Perera
Asst. Editor
Dr. Chandra Jayasuriya
Committee
Dr. Dennis Aloysius
Dr. M.S.G. de Silva
Prof. Ravindra Fernando
Prof. Colvin Gooneratne
Dr. Nalika Gunawardena
Prof. R.L. Jayakody
Dr. Lucian Jayasuriya
Dr. D.S. Liyanarachchi
Vidyajothi Prof. Rizvi Sheriff
Dr. Lalith Wijeratne
Co-opted Members
Dr. Philip G. Veerasingam
Dr. Deepa Wimalasena
Telephone: 011 2695300
E-mail: comsaa@rocketmail.com
A Blog-site relating to some aspects of the Colombo Medical School Alumni Association- CoMSAA - Faculty of Medicine, University of Colombo, P.O.Box 271, Kynsey Road, Colombo 8, Sri Lanka. A copy of a water colour painting of the Kynsey road side of the Medical Faculty, Colombo, Sri Lanka, by Prof. Tissa Kappagoda is shown above.
Monday, November 7, 2011
Saturday, November 5, 2011
Application form for membership in CoMSAA
Application for membership
Colombo Medical School Alumni Association (CoMSAA)
SURNAME (IN BLOCK CAPITALS):……………………………………………………………
OTHER NAMES:…………………………………………………………………………………
ACADEMIC QUALIFICATIONS:……………………………………………………………….
DESIGNATION:………………………………SLMC Registration no.(If available)…………………..
Eligibility for membership (Please complete only the information applicable to you)
Students of the Faculty of Medicine, University of Colombo/ University of Ceylon: Course of study……………………………………………………………………………
Year of entry ………………………………………………...............................................
Qualification/s obtained with year/s …………………………………………………….
Academics of the Faculty of Medicine, University of Colombo/ University of Ceylon:
Year of employment …………………………… Designation…………………..
Confirmed in service Yes / No
Graduates who have contributed to teaching activities of the Colombo Medical College Years of contribution and capacity………………………………………………….
Graduates who have contributed as administrative / non-academic staff of the Colombo Medical College
Years of contribution and designation..……………………………………………..
Chancellor/ Vice Chancellor of a Sri Lankan University that has a Faculty of Medicine Years of contribution and designation..……………………………………………..
Contact Details:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Current Address
(Home) (Office)
Telephone Home: ……………… Office: ……………… Mobile: ………………..
E mail address: ………………………………………………………………………….
………………………….. ……………………………..
Signature of Applicant Date
MEMBERSHIP FEE
The subscription for Life Membership is Rs. 5000.00. This is payable by cheque.
Cheques should be written in favour of COLOMBO MEDICAL SCHOOL ALUMNI ASSOCIATION, account no. 72262672 of Bank of Ceylon, Regent Street Branch.
The cheque/ cheque deposit slip together with the application form should be sent to Prof. Jennifer Perera, Treasurer CoMSAA, Faculty of Medicine, PO Box 271, Colombo, Sri Lanka.
For internet banking or telegraphic transfer please use the following information(Swift code: BCEYLKLX, Bank code : 7010; Branch code : 627) and drop an email to comsaa@rocketmail.com about the transfer.
Members who pay the membership fee before 31st December 2011, will become Founder Members of CoMSAA.
Prof. Athula Kaluarachchi
Secretary, CoMSAA
Faculty of Medicine,
P.O. Box 271, Kynsey Road,
Colombo 08, Sri Lanka.
Contact Details:
Postal Address: Email: comsaa@rocketmail.com
Phone: 0115849567
For office use only
Membership No:
Founder Member: Yes/ No
Membership Category: Full Member / Associate Member/ Honorary Member
Amount Paid:………………………
Receipt No: …………………........
Cheque number:…………………….
Eligibility: Eligible/ Not Eligible
Date of Approval by the Executive Committee:……………………………….
Date of informing the member:………………………………………………...
……………………………. ……………………………
Signature of the Secretary Date
Colombo Medical School Alumni Association (CoMSAA)
SURNAME (IN BLOCK CAPITALS):……………………………………………………………
OTHER NAMES:…………………………………………………………………………………
ACADEMIC QUALIFICATIONS:……………………………………………………………….
DESIGNATION:………………………………SLMC Registration no.(If available)…………………..
Eligibility for membership (Please complete only the information applicable to you)
Students of the Faculty of Medicine, University of Colombo/ University of Ceylon: Course of study……………………………………………………………………………
Year of entry ………………………………………………...............................................
Qualification/s obtained with year/s …………………………………………………….
Academics of the Faculty of Medicine, University of Colombo/ University of Ceylon:
Year of employment …………………………… Designation…………………..
Confirmed in service Yes / No
Graduates who have contributed to teaching activities of the Colombo Medical College Years of contribution and capacity………………………………………………….
Graduates who have contributed as administrative / non-academic staff of the Colombo Medical College
Years of contribution and designation..……………………………………………..
Chancellor/ Vice Chancellor of a Sri Lankan University that has a Faculty of Medicine Years of contribution and designation..……………………………………………..
Contact Details:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Current Address
(Home) (Office)
Telephone Home: ……………… Office: ……………… Mobile: ………………..
E mail address: ………………………………………………………………………….
………………………….. ……………………………..
Signature of Applicant Date
MEMBERSHIP FEE
The subscription for Life Membership is Rs. 5000.00. This is payable by cheque.
Cheques should be written in favour of COLOMBO MEDICAL SCHOOL ALUMNI ASSOCIATION, account no. 72262672 of Bank of Ceylon, Regent Street Branch.
The cheque/ cheque deposit slip together with the application form should be sent to Prof. Jennifer Perera, Treasurer CoMSAA, Faculty of Medicine, PO Box 271, Colombo, Sri Lanka.
For internet banking or telegraphic transfer please use the following information(Swift code: BCEYLKLX, Bank code : 7010; Branch code : 627) and drop an email to comsaa@rocketmail.com about the transfer.
Members who pay the membership fee before 31st December 2011, will become Founder Members of CoMSAA.
Prof. Athula Kaluarachchi
Secretary, CoMSAA
Faculty of Medicine,
P.O. Box 271, Kynsey Road,
Colombo 08, Sri Lanka.
Contact Details:
Postal Address: Email: comsaa@rocketmail.com
Phone: 0115849567
For office use only
Membership No:
Founder Member: Yes/ No
Membership Category: Full Member / Associate Member/ Honorary Member
Amount Paid:………………………
Receipt No: …………………........
Cheque number:…………………….
Eligibility: Eligible/ Not Eligible
Date of Approval by the Executive Committee:……………………………….
Date of informing the member:………………………………………………...
……………………………. ……………………………
Signature of the Secretary Date
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