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    CSP Membership Application Form: Renew

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    Anonymous PcPkRpAKD5
    This document is a membership application form for the Computing Society of the Philippines (CSP). It requests information such as the applicant's name, address, email, phone number, and membership details. The form provides options for payment including cash, check, or bank deposit. By signing, the applicant declares the information is true and acknowledges incorrect details could result in cancelled membership.

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    CSP Membership Application Form: Renew

    Uploaded by

    Anonymous PcPkRpAKD5
    90 views1 page
    This document is a membership application form for the Computing Society of the Philippines (CSP). It requests information such as the applicant's name, address, email, phone number, and membership details. The form provides options for payment including cash, check, or bank deposit. By signing, the applicant declares the information is true and acknowledges incorrect details could result in cancelled membership.

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    for info

    Original Title

    Membership Form _Individual

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    This document is a membership application form for the Computing Society of the Philippines (CSP). It requests information such as the applicant's name, address, email, phone number, and membership details. The form provides options for payment including cash, check, or bank deposit. By signing, the applicant declares the information is true and acknowledges incorrect details could result in cancelled membership.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    90 views1 page

    CSP Membership Application Form: Renew

    Uploaded by

    Anonymous PcPkRpAKD5
    This document is a membership application form for the Computing Society of the Philippines (CSP). It requests information such as the applicant's name, address, email, phone number, and membership details. The form provides options for payment including cash, check, or bank deposit. By signing, the applicant declares the information is true and acknowledges incorrect details could result in cancelled membership.

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    © All Rights Reserved
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    CSP MEMBERSHIP APPLICATION FORM (INDIVIDUAL)

    Submit this form to subscription@ittc.up.edu.ph or fax to 920-2036. Official Receipt may be obtained through the Office Secretariat at the UPITDC Office.

    *supply required information


    MEMBERSHIP

    *Membership Status: New Renew


    *Year of membership: Jan. 2019

    PERSONAL INFORMATION

    *Name:
    VERECIO ROMMEL LAGUTAN
    Last Name First Name Middle Name

    *Address:
    B11 L33&35 VILLA
    LOITA SUBD. COGON SAN JOSE 6500 TACLOBAN
    No. Street Barangay / Municipality Postal Code City / Province

    *E-mail address: rlverecio@lnu.edu.ph Cellphone No. 09977731522


    *Telephone No.
    **FOR INSTITUTIONAL MEMBERSHIP

    Position:
    Institution / Company:
    Address:
    E-mail address
    Telephone No: Fax No.

    *MODE OF PAYMENT

    Cash Check Bank Deposit


    Amount: Amount: Amount:
    Received by: Acct No. Acct No.
    Check No. Date Deposited:
    BDO Branch:

    I hereby declare that the information supplied in this application is true and complete. I
    acknowledge the provision that incorrect information may result in cancellation of membership.
    January 7, 2019
    Signature Date
    Membership is valid for 12 months form the date of purchase.
    **Institutional membership includes free 2 individual memberships.

    Computing Society of the Philippines (CSP)


    University of the Philippines Information Technology Development Center (UPITDC) 2/F Vidal A . Tan Hall, Quirino Ave . cor .
    Velasquez St .
    University of the Philippines, Diliman, Quezon City 1101 Philippines Tel: (02) 920 . 2080
    Fax: (02) 920 . 2036 website: http://www . csp . org . ph E - mail: subscription@ittc . up . edu . ph
    CSP-MAF JUNE 2012

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