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(Please Type and Print All Information) : Membership Application Form

The document is a membership application form for the Philippine Schools, Universities, and Colleges Computer Education and Systems Society (PSUCCESS). It requests personal information such as name, contact details, education and employment history. It also asks about areas of interest in PSUCCESS activities and membership type. Applicants must provide a sponsor's name and signature, as well as their own, and pay annual dues of either P300 for individual membership or P1,500-3,000 for institutional membership.

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Rodel D Dosano
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21 views2 pages

(Please Type and Print All Information) : Membership Application Form

The document is a membership application form for the Philippine Schools, Universities, and Colleges Computer Education and Systems Society (PSUCCESS). It requests personal information such as name, contact details, education and employment history. It also asks about areas of interest in PSUCCESS activities and membership type. Applicants must provide a sponsor's name and signature, as well as their own, and pay annual dues of either P300 for individual membership or P1,500-3,000 for institutional membership.

Uploaded by

Rodel D Dosano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PHILIPPINE SCHOOLS, UNIVERSITIES, AND COLLEGES

COMPUTER EDUCATION AND SYSTEMS SOCIETY (PSUCCESS) Attach your


latest passport
size picture
(2pcs.)
MEMBERSHIP APPLICATION FORM
(Please Type and print all information)

[ ] Original Membership
[ ] Reinstatement Application (former member)
Application

PERSONAL INFORMATION
First MI Last Name Nickname
Name
Date of Birth Civil Status Spouse Name No. of
Children
Residence
Address
Zip Code Tel. No. Cell
No. Email
Compan
y
Address
Zip Code
Position/ Title Tel. No. Fax No.

Industry (Description of Product or Service) Email


address
EDUCATION
School Attended Dates Degree Major
Minor
College
or
Business School
Graduate Work
If you attended graduate school but did not receive a degree, indicate major course taken and number of years completed.

PUBLICATIONS
Title
Year

WORK EXPERIENCE
Company Job Title Year

MEMBERSHIP IN ORGANIZATIONS/ CLUBS


Organization/ Club Position Held Year

AREAS OF INTEREST IN For Official Use Only


PSUCCESS ACTIVITIES
Others: Approved by:
[ ] Professional Devt (Seminars, [ ] Library & Research
Educ, etc)
[ ] Meetings (GMMs) [ ] Anniversary Celebration _________________________
_
[ ] Publications & Publicity [ ] Chapter Affairs Date of Induction
[ ] Membership: Acquisition/ [ ] Community Affairs
Retention _____________________
[ ] Fellowship & Sports [ ] Ethics Billing Date
[ ] Annual National Conference [ ] Students Affairs _____________________
[ ] Budget & Finance [ ] Ways & Means Membership Cert. No.

Hobbies
Talents
Sponsors Name Applicants Signature
Date

[ ] INDIVIDUAL MEMBERSHIP (Annual Dues) P 300.00


[ ] INSTITUTIONAL MEMBERSHIP (Annual Dues) P 1,500.00- (register three (3 ) institutional members, but if he/she is not
available to attend the monthly membership meetings of the association, you can send your
designated institutional representative)

(Please use extra sheet if space is not sufficient)

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