Mechatronics & Robotics Society of The Philippines: Membership Form

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MECHATRONICS & ROBOTICS SOCIETY OF THE PHILIPPINES

MEMBERSHIP FORM
Date:

INDIVIDUAL MEMBER
1. Name:
Family Name

Given Name

M.I

2. Residence Address
4. Highest Degree Earned/
Education
5. Name of School
Graduated
6. Job Description

3. Birth:
3.1 Sex: __________________
3.2 School Year ___________
3.3. Civil Status_____________

INSTITUTIONAL MEMBER
7 Company/Institution
Name
8 Company Address
Zip Code
9. Telephone / Fax:
Company Phone

Fax

Residence Phone

E-Mail Address
10. Other Related Experience: _____________________________________________________________________________
11. Area of Specialization: 1. ___________________
2. ___________________
3. ___________________
12. Mailing Address:

18. Signature: ____________________________________

O.R. Number: ____________________________________ Payment Received By: _______________________________


Date Issued: ___________________________________ O.R. Issued By: _____________________________________
Amount Collected:_____________________________________ Remarks: ______________________________________
Annual Membership Fees
(Society card is not included)
Elementary & High
P100.00
School Students
(Science/Technology Club Member)
College Students
200.00
Professionals/Industry
300.00
Practitioners/Scientists/
Engineers/Researchers/
Skilled Workers/Technicians
Institution/Enterprise
P2,000.00

Complete Address
Center for Engineering and Sustainable Development Research
(CESDR) V102, DLSU-MANILA, Tel_Fax +632 5360260
Email_adress: [email protected]
Or
Mechatronics Training Center(MTC), UP-ISSI Building,
Jacinto St. UP Diliman, Quezon City, Philippines , Tel No.
928-3307 Fax 928-6297, Email_address:
[email protected]

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