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    Philippine Association of Medical Technologists San Diego Chapter

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    pametsd
    This document is a membership application for the Philippine Association of Medical Technologists San Diego Chapter. It requests basic contact information from applicants such as name, address, phone number, email, education history, professional license, employer, area of specialty, and areas of interest. Applicants are asked if they are willing to share expertise. The annual membership fee is $20 and checks should be made payable to PAMET San Diego. Upon receipt of payment, a membership application receipt will be issued.

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    Philippine Association of Medical Technologists San Diego Chapter

    Uploaded by

    pametsd
    135 views1 page
    This document is a membership application for the Philippine Association of Medical Technologists San Diego Chapter. It requests basic contact information from applicants such as name, address, phone number, email, education history, professional license, employer, area of specialty, and areas of interest. Applicants are asked if they are willing to share expertise. The annual membership fee is $20 and checks should be made payable to PAMET San Diego. Upon receipt of payment, a membership application receipt will be issued.

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    PametApplicationFB[1]

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    This document is a membership application for the Philippine Association of Medical Technologists San Diego Chapter. It requests basic contact information from applicants such as name, address, phone number, email, education history, professional license, employer, area of specialty, and areas of interest. Applicants are asked if they are willing to share expertise. The annual membership fee is $20 and checks should be made payable to PAMET San Diego. Upon receipt of payment, a membership application receipt will be issued.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    135 views1 page

    Philippine Association of Medical Technologists San Diego Chapter

    Uploaded by

    pametsd
    This document is a membership application for the Philippine Association of Medical Technologists San Diego Chapter. It requests basic contact information from applicants such as name, address, phone number, email, education history, professional license, employer, area of specialty, and areas of interest. Applicants are asked if they are willing to share expertise. The annual membership fee is $20 and checks should be made payable to PAMET San Diego. Upon receipt of payment, a membership application receipt will be issued.

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    PHILIPPINE ASSOCIATION OF MEDICAL TECHNOLOGISTS

    SAN DIEGO CHAPTER


    9612 Oviedo Street San Diego, CA 92129
    Email: pametsandiego@yahoo.com
    Email yahoo group: PAMET-SanDiego@yahoogroups.com
    Website: pametsandiego.com

    Membership Application
    __________________________________________________________________________________________________________________________________________________

    Officers Name: ______________________________________________________________________________________________


    (2010-2012) Last First Middle/Maiden

    Loreto Negado Address: ____________________________________________________________________________________________


    President
    No. & Street City State Zip
    Estrelle Zarza
    First Vice President
    Phone#: ____________________________________ Email: _______________________________________________
    Lavenia Correa
    Second Vice President
    College/University Attended Degree/Major Year Graduated
    Annie Generoso
    Third Vice President ______________________________________________________________________________________________________
    Roger Mark Lariosa
    ______________________________________________________________________________________________________
    Recording Secretary ______________________________________________________________________________________________________

    Betty Crisostomo Professional License:


    Treasurer
    ______________________________________________________________________________________________________
    Ma. Charina Corkery ______________________________________________________________________________________________________
    Assistant Treasurer
    Employer: _________________________________________________________________________
    Marie Parayno
    Auditor
    Address: ___________________________________________________________________________
    Eva Abergas
    P.R.O. Area of Specialty: (Ex. Chem,. Hematology, etc.)
    Paul Generoso
    ______________________________________________________________
    Business Manager
    Area of Interest/Experience:
    Chito Gaza ___ Organization as ___ Leader ___ Lecturer ___ Music
    Liza Albano
    Virginia Salvador
    ___ Planner ___ Writing ___ Office Skills
    Members at Large ___ Group member ___ Proctor ___ Other__________________

    Merlie Aquiler Are you willing to share any of these interest/experience to the association? ______________
    Emma Peter
    Mila Perez Signature: __________________________________________________ Date: ________________________________
    Loreta Sigarlaki
    Tess Respicio
    Malyn Rubias Annual membership Fee: $20.00 Please make check payable to: PAMET-San Diego
    Board of Directors Mail form and check to: Betty Crisostomo OFFICIAL USE ONLY
    11430 Larmier Circle PAID: $_________________________
    San Diego, CA 92131 Check # _______________________
    Date Rec: ______________________
    By: _____________________________

    ***************************************************************************************************************
    Membership Application Receipt:

    Received annual membership application fee for PAMET San Diego Check: # _________________
    Amount: $20.00 Cash: _____________________
    Date Rec: ________________
    Name: ____________________________________________________________ By: _______________________

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