OBU Membership RegistrationPersonal Information *First Name * First NameFirst Name can not be left blank.Please enter valid data.Please enter valid data.This first name is invalid. Please enter a valid first name.*Last Name * Last NameLast Name can not be left blank.Please enter valid data.Please enter valid data.This last name is invalid. Please enter a valid last name.*Date of Birth * Date of BirthPlease select Date of BirthInvalid Date.*National ID Number * National ID NumberNIC Number cannot be left blank.Please enter valid data.Maximum 14 characters allowed.Please enter valid data.*Residential Address * Residential AddressText field can not be left blank.Please enter valid data.Phone Number (Fixed) Phone Number (Fixed)Phone Number cannot be left blank.Please enter valid data.*Phone Number (Mobile) * Phone Number (Mobile)Text field can not be left blank.Please enter valid data.Professional Details Name of Company Name of CompanyText field can not be left blank.Please enter valid data.Business Address Business AddressText field can not be left blank.Please enter valid data.*Occupation * OccupationOccupation cannot be left blank.Please enter valid data.*Email Address * Email AddressEmail Address can not be left blank.Please enter valid email address.Please enter valid email address.This email is already registered, please choose another one.Academic Details *Period at Wesley College * Period at Wesley CollegeAcademic Period cannot be left blank.Please enter valid data.From – ToAdmission Number Admission NumberText field can not be left blank.Please enter valid data.Please enter valid data.Verification and Payment *Proposer Name * Proposer NameProposer Name cannot be left blank.Please enter valid data.Please enter valid data.*Proposer Membership Number * Proposer Membership NumberProposer Membership number cannot be left blank.Please enter valid data.Please enter valid data.*Seconder Name * Seconder NameSeconder Name cannot be left blank.Please enter valid data.Please enter valid data.*Seconder Membership Number * Seconder Membership NumberSeconder Membership Number cannot left blank.Please enter valid data.Please enter valid data.Copy of Result Sheet/Leaving Certificate Copy of Result Sheet/Leaving CertificateDrop file here or click to select.Please select file.Invalid file selected.Invalid file selected.If you are an Old Boy who left school within last 3 years*Upload Bank Deposit Receipt * Upload Bank Deposit ReceiptDrop file here or click to select.Please select file.Invalid file selected.Invalid file selected.Upload a copy of the bank deposit receipt made to the Wesley College OBU for your membership*Username * UsernameUsername cannot be left blank.Please enter valid data.This username is already registered, please choose another one.This username is invalid. Please enter a valid username.Enter a desired username*Password * PasswordPassword cannot be left blank.Please enter valid data.Please enter at least 6 characters.Strength: Very Weak*Confirm Password * Confirm PasswordConfirm Password can not be left blank.Passwords don’t match. Passwords don’t match.SubmitcropSkip(Use Cropper to set image and use mouse scroller for zoom image.)