Full Name / Organization Name: *
Date of Birth / Incorporation: *
National ID / Passport / Trade License: *
Gender *
Occupation / Industry
Designation
Nationality *
Email *
Mobile *
Address (Present & Permanent) *
Website / Social Media *
Membership Category Applied For *
SECTION B: NOMINATORS / REFERENCES
NOMINATORS / REFERENCES
SECTION C: NOMINEES (Corporate / Family)
NOMINEES (Corporate / Family)
SECTION D: STATEMENT OF INTEREST (Max 250 words)
Explain alignment with CCCL mission:
Culture *
Youth *
Innovation *
Legacy *
SECTION E: PROFESSIONAL & CIVIC ENGAGEMENT
Cultural Contributions *
Club Memberships *
Leadership Experience *
SECTION 3: DOCUMENT CHECKLIST
DOCUMENT CHECKLIST *
Upload Selected Documents *
Maximum file size: 20 MB
All information is accurate *
No criminal record *
Agree to ethics *
Conflict of Interest *
If declared, explain

Financial Integrity

  • Funds are from legitimate sources
  • No financial misconduct history

Commitment to CCCL

  • Maintain professionalism
  • Actively contribute
  • Promote culture responsibly
Applicant Signature *
Maximum file size: 5 MB
Submission Date
Guardian Signature (Youth)
Maximum file size: 5 MB

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